Basic Information
| Provider Information | |||||||||
| NPI: | 1689916637 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVRI | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | MARIO | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2005 TECHNOLOGY PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170509413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177912520 | ||||||||
| FaxNumber: | 7177030061 | ||||||||
| Practice Location | |||||||||
| Address1: | 2005 TECHNOLOGY PKWY STE 400 | ||||||||
| Address2: | |||||||||
| City: | MECHANICSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170509413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177912520 | ||||||||
| FaxNumber: | 7177030061 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2013 | ||||||||
| LastUpdateDate: | 07/14/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS018753 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 1218 | NE | N | Allopathic & Osteopathic Physicians | General Practice | 207QS1201X | OS018753 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 103358916 | 05 | PA | MEDICAID |