Provider Demographics
NPI:1831423474
Name:LEVY, MARCIA G (RD, MED, LD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:G
Last Name:LEVY
Suffix:
Gender:F
Credentials:RD, MED, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 ARMS DR
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:OH
Mailing Address - Zip Code:44420-1604
Mailing Address - Country:US
Mailing Address - Phone:330-759-0396
Mailing Address - Fax:
Practice Address - Street 1:125 CHURCHILL HUBBARD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44505-1322
Practice Address - Country:US
Practice Address - Phone:330-759-3394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH707132133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH133V00000XMedicare PIN