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Individual

BRUCE LEVINE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
24670 GOTHAM STREET RD, CARRIAGE HOUSE, WATERTOWN, NY 13601-4290
(303) 385-7368
Mailing address
24670 GOTHAM STREET RD, CARRIAGE HOUSE, WATERTOWN, NY 13601-4290
(303) 385-7368

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
TD60632655
WA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
242658
NY
2084P0804X
Child & Adolescent Psychiatry Physician
46758
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
50385755
CO
Enumeration date
05/19/2008
Last updated
11/15/2016
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