1427250695 NPI number — LINDA H. LEAVENWORTH, M.D., P.C.

Table of content: (NPI 1427250695)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427250695 NPI number — LINDA H. LEAVENWORTH, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA H. LEAVENWORTH, M.D., P.C.
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:
1427250695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
411 MASSACHUSETTS AVENUE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ACTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-635-0477
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
411 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ACTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01720-3739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-635-0477
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEAVENWORTH
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
H
Authorized Official Title or Position:
DIRECT OWNER
Authorized Official Telephone Number:
978-635-0477

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  56101 , 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: J06513 . This is a "BCBS INDIVDUAL PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1938517 . This is a "CIGNA PROVIDER ID#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 056101 . This is a "TUFTS PROVIDER #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3023311 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2018428 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0700573 . This is a "UNITED HEALTHCARE ID#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 13614 . This is a "HPHC PROVIDER#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M16905 . This is a "BCBS OF MA GRP#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7166 . This is a "FALLON PROVIDER ID#" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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