Individual
JONATHAN A LEVISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
375 WAMPANOAG TRL, RIVERSIDE, RI 02915-2232
(401) 649-4020
(401) 649-4021
Mailing address
110 ELM ST, PROVIDENCE, RI 02903-4626
(401) 443-4992
(401) 537-7241
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD11650
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110127773A
—
MA
05
—
7057660
—
RI
Enumeration date
04/22/2006
Last updated
03/23/2023
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