Provider Demographics
NPI:1093752651
Name:LEVINE, JOHN B (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:124 GROVE ST.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:FRANKLIN
Mailing Address - State:MA
Mailing Address - Zip Code:02038-3156
Mailing Address - Country:US
Mailing Address - Phone:508-528-5392
Mailing Address - Fax:508-541-2420
Practice Address - Street 1:14 PROSPECT STREET
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3003
Practice Address - Country:US
Practice Address - Phone:508-482-5444
Practice Address - Fax:508-482-5408
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2011-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA1597612084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110007102/AMedicaid