Provider Demographics
NPI:1144273400
Name:LEVINE, MARC L (M D)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 S JOG RD STE 205
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2981
Mailing Address - Country:US
Mailing Address - Phone:561-732-6767
Mailing Address - Fax:561-732-6701
Practice Address - Street 1:82OO JOG RD.
Practice Address - Street 2:SUITE 205
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472
Practice Address - Country:US
Practice Address - Phone:561-732-6767
Practice Address - Fax:561-732-6701
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01663207RC0000X
FLME78197207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2016-01663OtherSTATE LICENSES
FL46826OtherBLUE CROSS BLUE SHIELD FL
FL262170300Medicaid
FL262170300Medicaid
NC2016-01663OtherSTATE LICENSES