Individual
MARIANNE ROSE LEVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
3440 CAMP BOWIE BOULEVARD, FORT WORTH, TX 76107-2729
(817) 735-2363
(817) 735-2653
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
(817) 735-2363
(817) 735-2653
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
H0561
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134206505
—
TX
01
—
134206507
CSHCN
TX
01
—
370014522
RAILROAD MEDICARE PIN
TX
01
—
87761G
BCBS
TX
Enumeration date
04/17/2006
Last updated
03/16/2010
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