Basic Information
| Provider Information | |||||||||
| NPI: | 1962461202 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEVITAN | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 678 | ||||||||
| Address2: | |||||||||
| City: | LACONIA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032470678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6035243211 | ||||||||
| FaxNumber: | 2159236225 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 AIKEN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | NH | ||||||||
| PostalCode: | 032351259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6039342060 | ||||||||
| FaxNumber: | 2154568502 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2006 | ||||||||
| LastUpdateDate: | 12/29/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD058632L | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001588674 | 05 | PA | MEDICAID |