Basic Information
Provider Information
NPI: 1811976798
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEVIN
FirstName: ALAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14275 MIDWAY RD
Address2: SUITE 400
City: ADDISON
State: TX
PostalCode: 750013614
CountryCode: US
TelephoneNumber: 2149328029
FaxNumber: 6102714245
Practice Location
Address1: 8150 CHANCELLOR DR
Address2: SUITE 110
City: ORLANDO
State: FL
PostalCode: 328097691
CountryCode: US
TelephoneNumber: 4075874243
FaxNumber: 4072515053
Other Information
ProviderEnumerationDate: 01/10/2006
LastUpdateDate: 04/23/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0102XME0033612FLY Allopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology

No ID Information.


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