1710987607 NPI number — DR. MARILYN L LEVINE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710987607 NPI number — DR. MARILYN L LEVINE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LEVINE

Provider First Name:

MARILYN

Provider Middle Name:

L

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

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:

1710987607

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/21/2008

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

260 NEW LUDLOW RD

Provider Second Line Business Mailing Address:

WESTERN MASS PHYSICIAN ASSOCIATES, INC.

Provider Business Mailing Address City Name:

CHICOPEE

Provider Business Mailing Address State Name:

MA

Provider Business Mailing Address Postal Code:

01020-4324

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

413-533-3470

Provider Business Mailing Address Fax Number:

413-533-6859

Provider First Line Business Practice Location Address:

2 HOSPITAL DR STE 101

Provider Second Line Business Practice Location Address:

D/B/A: HOLYOKE ASSOCIATES IN INTERNAL MEDICINE

Provider Business Practice Location Address City Name:

HOLYOKE

Provider Business Practice Location Address State Name:

MA

Provider Business Practice Location Address Postal Code:

01040-6616

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

413-536-8924

Provider Business Practice Location Address Fax Number:

413-532-9141

Provider Enumeration Date:

07/21/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  33365 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RH0000X , with the licence number: 33365 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 2003708 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
• Identifier: 100070 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: G10005 . This is a "HMO BLUE" identifier . This identifiers is of the category "OTHER".
• Identifier: 033365 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
• Identifier: 000000007941 . This is a "BOSTON MEDICAL CENTER-HNP" identifier . This identifiers is of the category "OTHER".
• Identifier: 2003708 . This is a "MEDICAID - PCC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
• Identifier: 13900 . This is a "HEALTH NEW ENGLAND" identifier . This identifiers is of the category "OTHER".
• Identifier: 981296 . This is a "NETWORK HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 0003029 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: G10005 . This is a "BLUECARE 65" identifier . This identifiers is of the category "OTHER".
• Identifier: 66448 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".