Provider Demographics
NPI:1861584997
Name:LEVINSON, ELCON (MD)
Entity type:Individual
Prefix:
First Name:ELCON
Middle Name:
Last Name:LEVINSON
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 1:26 SAINT ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4050
Mailing Address - Country:US
Mailing Address - Phone:860-673-0682
Mailing Address - Fax:
Practice Address - Street 1:1 TOWNE PARK PLZ
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2247
Practice Address - Country:US
Practice Address - Phone:860-886-1433
Practice Address - Fax:860-886-4644
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0395062085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI327060OtherBCBS
RI1600097OtherUNITED HEALTH
RIEL67101Medicaid
RI007060083OtherMEDICARE PROVIDER NUMBER-RI
CT001173129Medicaid
RI04120OtherNEIGHBORHOOD
RI411814OtherMEDICARE GROUP
RI414191OtherBCHIP
RI414191OtherBCHIP
RI007060083OtherMEDICARE PROVIDER NUMBER-RI
CT300002133Medicare ID - Type Unspecified