Provider Demographics
NPI:1164454682
Name:LEBOW, JOANNE M (MD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:LEBOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:LEBOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:41 MALL ROAD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01805-0001
Mailing Address - Country:US
Mailing Address - Phone:855-934-4488
Mailing Address - Fax:
Practice Address - Street 1:50 MALL ROAD
Practice Address - Street 2:SUITE G03
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-366-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251353-1207R00000X
MA122741207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine