Provider Demographics
NPI:1063610558
Name:PICARD, ALICIA ANNE LEVIN (MD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE LEVIN
Last Name:PICARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:ANNE
Other - Last Name:LEVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:LANKENAU HOSPITAL RADIOLOGY DEPT
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-429-0693
Mailing Address - Fax:610-429-9048
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:LANKENAU HOSPITAL RADIOLOGY DEPT
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-429-0693
Practice Address - Fax:610-429-9048
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1906672085R0202X
PAMD4452712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology