DR. JERRY ISADORE LEVINE (NPI# 1295736429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295736429 |
| Entity Type | Individual |
| Full Name | DR. JERRY ISADORE LEVINE |
| Credential | M.D. |
| Practice Address |
11055 Little Patuxent Pkwy Suite 104 Columbia MD 21044-2896 |
| Mailing Address |
1111 Benfield Blvd Suite 200 Millersville MD 21108-3002 |
| Practice Telephone | 4107402900 |
| Practice Fax Number | 4107402955 |
| Mailing Telephone | 4107295100 |
| Mailing Fax Number | 4107295156 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2011-01-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | D0022856 | MD | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | CIGNA PIN | 1865815 | 01 |
| MD | CAREFIRST BLUECHOICE | 3509-0004 | 01 |
| MD | CAREFIRST MD RENDERING | 366910-01 | 01 |
| MD | AETNA FEE FOR SERVICE | 4238661 | 01 |
| MD | AETNA CAPITATED | 0477651 | 01 |
| MD | CAREFIRST MPOS | P12725 | 01 |
| MD | MAMSI PRIMARY CARE | 843368 | 01 |
| MD | JHHC PROVIDER NUMBER | 020550 | 01 |
| MD | RR MEDICARE | 110142478 | 01 |
| MD | MAMSI SPECIALIST | 243368 | 01 |
| MD | 780581100 | 05 |
| Street Address |
11055 LITTLE PATUXENT PKWY SUITE 104 |
| City | COLUMBIA |
| State | MD |
| Zip Code | 21044-2896 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992706618 | Bruce Michael Conger | Internal Medicine | 11055 Little Patuxent Pkwy, Suite103, Columbia, MD 21044-2896 | 2005-08-03 |
| 1861868622 | Foot and Ankle Specialists of The Mid-atlantic, LLC | Podiatrist | 11055 Little Patuxent Pkwy, Suite 204, Columbia, MD 21044-2896 | 2015-08-17 |
| 1427434521 | Stacy Bartolich | Nurse Practitioner | 11055 Little Patuxent Pkwy, Suite 205, Columbia, MD 21044-2896 | 2015-07-31 |
| 1225462963 | Centers for Advanced Orthopaedics, LLC | Orthopaedic Surgery | 11055 Little Patuxent Pkwy, Suite L-1, Columbia, MD 21044 | 2013-08-29 |
| 1356645220 | Howard Open Mri LLC | Clinic/Center | 11055 Little Patuxent Pkwy, Suite L9, Columbia, MD 21044-2896 | 2011-01-06 |
| 1548562119 | St. Agnes Healthcare, Inc. | Clinic/Center | 11055 Little Patuxent Pkwy, L6, Columbia, MD 21044-2896 | 2010-12-02 |
| 1427380302 | Maryland Ivf Fertility Health & Wellness Center | Clinic/Center | 11055 Little Patuxent Pkwy, Columbia, MD 21044-2896 | 2010-02-03 |
| 1124250923 | Katherine Mansfield Houle | Social Worker | 11055 Little Patuxent Pkwy, Suite 201, Columbia, MD 21044-2896 | 2009-08-13 |
| 1336374321 | Rafeena Bacchus | Internal Medicine | 11055 Little Patuxent Pkwy, Suite 104, Columbia, MD 21044-2896 | 2009-05-20 |
| 1902075997 | Charles J. Lancelotta Jr., M.d., P.a. | Specialist | 11055 Little Patuxent Pkwy, Suite L7, Columbia, MD 21044-2896 | 2008-02-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821699331 | Brightview Columbia, LLC | Alzheimer Center (Dementia Center) | 6670 Martin Road, Columbia, MD 21044 | 2020-11-03 |
| 1689291544 | Diana Matthews | Physical Therapist | 6016 Jerrys Drive, Columbia, MD 21044 | 2020-06-26 |
| 1902380926 | Bagiwa Healthcare Services LLC | Nursing Care | 10630 Little Patuxent Park Way, Suite 314i, Colombia, MD 21044 | 2018-09-17 |
| 1295228245 | April Bloom Assisted Living, LLC | Assisted Living Facility | 5037 East Durham Rd, Columbia, MD 21044 | 2018-06-13 |
| 1437659562 | La Shawna A Obame | Counselor | 10451 Twin Rivers Rd Ste 100, Columbia, MD 21044 | 2018-02-15 |
| 1205335262 | Rashida Annette Winestock | Registered Nurse | 10440 Little Patuxent Pkwy 800, Columbia, MD 21044 | 2018-02-06 |
| 1215436274 | Terri Lynn Buzby | Registered Nurse | 10440 Little Patuxuent Pkwy 800, Columbia, MD 21044 | 2018-02-06 |
| 1134628191 | Sarah Elizabeth Stiltner | Registered Nurse | 10440 Little Patuxent Pkwy Suite 800, Columbia, MD 21044 | 2018-02-06 |
| 1326547381 | David Oliver Sloan Jr. | Registered Nurse | 10440 Little Patuxent Parkway Suite 800, Columbia, MD 21044 | 2018-02-06 |
| 1467950980 | Jill Sheppard Davenport | Nutritionist | 10801 Hickory Ridge Rd Suite 215, C/o Holistic Child Psychiatry, Columbia, MD 21044 | 2018-01-30 |
| Find all providers in zip 21044 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808815 | Thai Quoc Nguyen | Internal Medicine | University Hospital Ma421 Med Sciences Bldg, Columbia, MO 65212-0001 | 2020-07-06 |
| 1649898784 | Peter Egwom | Internal Medicine | University Hospital One Hospital Drive Dc.043.00, Columbia, MO 65212-0001 | 2020-07-06 |
| 1790302362 | Klariz Teves Tucker | Internal Medicine | Internal Medcine Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-30 |
| 1851918346 | Maxwell Isaac | Internal Medicine | University Hospital 1 Hospital Drive Dc 043.00, Columbia, MO 65212-0001 | 2020-06-30 |
| 1285251983 | Shannon Ejiofor | Internal Medicine | University Hospital One Hospital Drive Dc043.00, Columbia, MO 65212-0001 | 2020-06-29 |
| 1336766278 | Jordan Stauffer | Internal Medicine | University Hospital One Hospital Dr, Columbia, MO 65212-0001 | 2020-06-26 |
| 1972120814 | Pak Ho Au | Internal Medicine | University Hospital One Hospital Dr Dc043.00, Columbia, MO 65212-0001 | 2020-06-26 |
| 1700402849 | Michael Allan Goble | Internal Medicine | Internal Medical Center, 1801 Sunset Drive, Columbia, SC 29203 | 2020-06-24 |
| 1740806389 | Alan Verl Godfrey | Internal Medicine | University of Missouri Hospital 1 Hospital Dr, Columbia, MO 65212-0001 | 2020-06-19 |
| 1003432642 | Gregory Gaskey | Internal Medicine | University of Missouri Hospital One Hospital Drive, Columbia, MO 65212-0001 | 2020-06-19 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.