Basic Information
| Provider Information | |||||||||
| NPI: | 1548436025 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | NAVEH | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6725 POST ROAD | ||||||||
| Address2: | XRA IMAGING ASSOCIATES | ||||||||
| City: | NORTH KINGSTOWN | ||||||||
| State: | RI | ||||||||
| PostalCode: | 02852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4018864830 | ||||||||
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| Practice Location | |||||||||
| Address1: | 455 TOLL GATE RD | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028862759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4017371010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2008 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 4301091796 | MI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD12965 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1548436025 | 05 | MI | MEDICAID |