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Organization

SPACE COAST MEDICAL ASSOCIATES LLP

Active
Organization subpart
No

Provider details

NPI number
Authorized official
RICHARD LEVINE MD (MANAGING PARTNER)
(321) 454-9001
Entity
Organization

Contact information

Practice address
490 N WASHINGTON AVE, TITUSVILLE, FL 32796-2871
(311) 268-4200
Mailing address
490 N WASHINGTON AVE, TITUSVILLE, FL 32796-2871
(311) 268-4200

Taxonomy

Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
253792300
FL
05
253792301
FL
05
253792303
FL
05
253792304
FL
05
253792305
FL
05
253792307
FL
01
6992550001
PTAN
FL
Enumeration date
05/01/2006
Last updated
07/29/2014
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