1669449732 NPI number — MS. DEBRA L LEVINE NP

Table of content: MS. DEBRA L LEVINE NP (NPI 1669449732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669449732 NPI number — MS. DEBRA L LEVINE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEVINE
Provider First Name:
DEBRA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEVINE-SMITH
Provider Other First Name:
DEBRA
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669449732
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
65 HALF CROWN CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01721-3922
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-881-2887
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 UNION STREET
Provider Second Line Business Practice Location Address:
METROWEST MEDICAL CENTER
Provider Business Practice Location Address City Name:
NATICK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01760-6776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-650-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2006

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: 363L00000X , with the licence number:  247231 , 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: 91288 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NP4787 . This is a "BLUE CROSS SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0700932 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9353597 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".