1164577995 NPI number — BARRY L LEVIN MD

Table of content: (NPI 1164577995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164577995 NPI number — BARRY L LEVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARRY L LEVIN MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164577995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 845039
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-5039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-341-0060
Provider Business Mailing Address Fax Number:
978-341-0063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 ORNAC
Provider Second Line Business Practice Location Address:
SUITE 760
Provider Business Practice Location Address City Name:
CONCORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01742-4181
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-341-0060
Provider Business Practice Location Address Fax Number:
978-341-0063
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEVIN
Authorized Official First Name:
BARRY
Authorized Official Middle Name:
LESTER
Authorized Official Title or Position:
OWNER OF PRACTICE
Authorized Official Telephone Number:
978-341-0060

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  52012 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2121133 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6146511 . This is a "E D S" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 712959 . This is a "TUFTS MEDICARE PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M19056 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 130024913 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 96741 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11029 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1117362 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6146511 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 712959 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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