Provider Demographics
NPI:1356308548
Name:AGDERE, LEVON (MD)
Entity type:Individual
Prefix:DR
First Name:LEVON
Middle Name:
Last Name:AGDERE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 26246
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-6246
Mailing Address - Country:US
Mailing Address - Phone:718-604-5574
Mailing Address - Fax:718-604-5527
Practice Address - Street 1:342 KINGSBOROUGH 3RD WALK
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3677
Practice Address - Country:US
Practice Address - Phone:718-778-1003
Practice Address - Fax:718-493-4784
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1738662080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE17742Medicare UPIN