Active NPI
Mark J Le Vine, MD
- Dermatology Physician
- Euclid, OH
National Provider Identifier
1245308451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- 35043529
- Practice address
- 2630 Euclid Ave
#736
Euclid, OH 44132 - Phone
- (216) 261-3376
- Fax
- (216) 261-3926
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | 35043529 | OH | Primary |
Addresses
Primary practice location
2630 Euclid Ave
#736
Euclid, OH 44132
Mailing address
2630 Euclid Ave
#736
Euclid, OH 44132
Phone (216) 261-3376
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0403227 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35043529 | OH | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245308451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2630 EUCLID AVE",
"address_2": "#736",
"city": "EUCLID",
"state": "OH",
"postal_code": "44132",
"telephone_number": "216-261-3376",
"fax_number": "216-261-3926"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2630 EUCLID AVE",
"address_2": "#736",
"city": "EUCLID",
"state": "OH",
"postal_code": "44132",
"telephone_number": "216-261-3376",
"fax_number": "216-261-3926"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LE VINE",
"first_name": "MARK",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "OH",
"license": "35043529",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0403227",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Euclid, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.