Provider Demographics
NPI:1043280217
Name:LEVINE, LOIS R (MD)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:R
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S ELISEO DR
Mailing Address - Street 2:#101
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904
Mailing Address - Country:US
Mailing Address - Phone:415-464-0184
Mailing Address - Fax:415-464-0295
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:#101
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904
Practice Address - Country:US
Practice Address - Phone:415-464-0184
Practice Address - Fax:415-464-0295
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37940207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C379400Medicaid
A36799Medicare UPIN
00C379400Medicare ID - Type Unspecified