Provider Demographics
NPI:1235355694
Name:MARK DAVID LEVINE, MD MENLO PARK PC
Entity type:Organization
Organization Name:MARK DAVID LEVINE, MD MENLO PARK PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:LEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-479-2960
Mailing Address - Street 1:4626 2ND ST
Mailing Address - Street 2:101
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-9446
Mailing Address - Country:US
Mailing Address - Phone:530-747-2022
Mailing Address - Fax:530-747-2029
Practice Address - Street 1:1600 ADAMS DR
Practice Address - Street 2:
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-1449
Practice Address - Country:US
Practice Address - Phone:650-688-5890
Practice Address - Fax:650-688-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty