Provider Demographics
NPI:1548250632
Name:LEVY, SANFORD (MD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 33RD AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4908
Mailing Address - Country:US
Mailing Address - Phone:206-601-1737
Mailing Address - Fax:
Practice Address - Street 1:128 33RD AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112
Practice Address - Country:US
Practice Address - Phone:206-324-2923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00016798207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0165786OtherDEPT OF LABOR & INDUSTRIE
WA1117084Medicaid
WA050091449OtherRAILROAD MEDICARE
WALE2878OtherREGENCE BLUE SHIELD
WALE2878OtherREGENCE BLUE SHIELD
WAGAB34810Medicare ID - Type Unspecified