Basic Information
| Provider Information | |||||||||
| NPI: | 1659615425 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK N LEVY DPM PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 SEVEN LOCKS RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208542931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017624636 | ||||||||
| FaxNumber: | 3017626228 | ||||||||
| Practice Location | |||||||||
| Address1: | 1201 SEVEN LOCKS RD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208542931 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017624636 | ||||||||
| FaxNumber: | 3017626228 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/19/2012 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEVY | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | NEAL | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3017624636 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 00534 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery |
ID Information
| ID | Type | State | Issuer | Description | 79394 | 05 | MD | MEDICAID |