Basic Information
| Provider Information | |||||||||
| NPI: | 1811991540 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVINE | ||||||||
| FirstName: | LARRY | ||||||||
| MiddleName: | R. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | V J DILELLA DO, LLC | ||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277385037 | ||||||||
| Practice Location | |||||||||
| Address1: | 703 VIRGINIA ST | ||||||||
| Address2: | V J DILELLA, DO LLC | ||||||||
| City: | DUNEDIN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346986615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7277344000 | ||||||||
| FaxNumber: | 7277385037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2005 | ||||||||
| LastUpdateDate: | 01/22/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | OS6010 | FL | Y | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | OS0006010 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 044135000 | 05 | FL | MEDICAID | 21762 | 01 | FL | BCBS | OTHER | 82873K | 01 | FL | MEDICARE | OTHER | E32308 | 01 | FL | MEDICARE UPIN | OTHER |