Provider Demographics
NPI:1164412896
Name:LEVITSKY, LYNNE L (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:L
Last Name:LEVITSKY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-2909
Mailing Address - Fax:617-724-0581
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:YAW 6 PEDIATRIC ENDOCRINE ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-726-2909
Practice Address - Fax:617-724-0581
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2012-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA71822208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA071822OtherTUFTS HEALTH PLAN
MA3057640Medicaid
MAJ09202OtherBCBS MA
MAJ09202Medicare ID - Type Unspecified
MA071822OtherTUFTS HEALTH PLAN