1528156056 NPI number — MR. CHARLES GEORGE LEVENTIS M.ED LADC1

Table of content: MR. CHARLES GEORGE LEVENTIS M.ED LADC1 (NPI 1528156056)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528156056 NPI number — MR. CHARLES GEORGE LEVENTIS M.ED LADC1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVENTIS
Provider First Name:
CHARLES
Provider Middle Name:
GEORGE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.ED LADC1
Provider Gender Code:
M

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:
1528156056
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 CIRCLE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANFORD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04073-2402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-740-1570
Provider Business Mailing Address Fax Number:
978-741-1304

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 CONGRESS ST
Provider Second Line Business Practice Location Address:
105
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01970-7309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-700-1570
Provider Business Practice Location Address Fax Number:
978-741-1304
Provider Enumeration Date:
10/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  227 , 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)





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