Provider Demographics
NPI:1295731131
Name:LEVY, DAVID LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LAWRENCE
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 STATE ST
Mailing Address - Street 2:STE 321
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6638
Mailing Address - Country:US
Mailing Address - Phone:207-973-8833
Mailing Address - Fax:207-973-8836
Practice Address - Street 1:417 STATE ST
Practice Address - Street 2:STE 321
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6638
Practice Address - Country:US
Practice Address - Phone:207-973-8833
Practice Address - Fax:207-973-8836
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME010259207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME302030099Medicaid
MEC66555Medicare UPIN
ME053129Medicare ID - Type Unspecified