Provider Demographics
NPI:1356728406
Name:LEVINE, ZACHARY (MAC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GRANITE POINT PL
Mailing Address - Street 2:
Mailing Address - City:OWLS HEAD
Mailing Address - State:ME
Mailing Address - Zip Code:04854-3639
Mailing Address - Country:US
Mailing Address - Phone:207-975-9776
Mailing Address - Fax:
Practice Address - Street 1:22 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2710
Practice Address - Country:US
Practice Address - Phone:207-975-9776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC517171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist