Basic Information
| Provider Information | |||||||||
| NPI: | 1841281417 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVINE | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | M | ||||||||
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| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 METRO CENTER BLVD STE 2000 | ||||||||
| Address2: | |||||||||
| City: | WARWICK | ||||||||
| State: | RI | ||||||||
| PostalCode: | 028861785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4014322520 | ||||||||
| FaxNumber: | 4014538220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2005 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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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 | 2085R0202X | 9251 | RI | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MD09251 | RI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 000000001988 | 01 | NHPRI | OTHER | 16 00203 | 01 | UNITED HEALTH PLANS | OTHER | 007005472 | 01 | HOSPITAL PIN | OTHER | 241368 | 01 | RIH PILGRIM | OTHER | 3200400 | 01 | MASSMEDICAID | OTHER | 3200400 | 01 | HEALTHY START | OTHER | 7005470 | 01 | RI MEDICAL ASSISTANCE | OTHER | 720053001 | 01 | CIGNA | OTHER | 400131 | 01 | BLUE CHIP | OTHER | 077530 | 01 | TUFTS | OTHER | 300067446 | 01 | RAILROAD MEDICARE | OTHER | 00 3117216 | 01 | CT MED ASSISTANCE | OTHER | 009251 | 01 | BLUE SHIELD | OTHER |