1518054063 NPI number — DR. ERIC J LEVIN MD

Table of content: DR. ERIC J LEVIN MD (NPI 1518054063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518054063 NPI number — DR. ERIC J LEVIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVIN
Provider First Name:
ERIC
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1518054063
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:
450 NORTH MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHARON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02067
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-784-0403
Provider Business Mailing Address Fax Number:
781-784-0407

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 NORTH MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHARON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-784-0403
Provider Business Practice Location Address Fax Number:
781-784-0407
Provider Enumeration Date:
10/06/2006

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: 208000000X , with the licence number:  79350 , 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: 0473852 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07930 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3130681 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200944 . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1240551 . This is a "UNITED HC" identifier . This identifiers is of the category "OTHER".
  • Identifier: J14677 . This is a "BLUE CROSS BLUE SHIELD MA" identifier . This identifiers is of the category "OTHER".




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