Basic Information
| Provider Information | |||||||||
| NPI: | 1699010009 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK D. LEVINE, M.D., HOME TELEMEDICINE, PROFESSIONAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2081 ARENA BLVD STE 160 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958342309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165767898 | ||||||||
| FaxNumber: | 9162850338 | ||||||||
| Practice Location | |||||||||
| Address1: | 2081 ARENA BLVD STE 160 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958342309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9165767898 | ||||||||
| FaxNumber: | 9162850338 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2012 | ||||||||
| LastUpdateDate: | 12/11/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEVINE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9165767898 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.