Provider Demographics
NPI:1205863461
Name:MARKOWITZ, LARRY (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:MARKOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 LIBBEY PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3100
Mailing Address - Country:US
Mailing Address - Phone:781-335-3900
Mailing Address - Fax:781-337-9424
Practice Address - Street 1:90 LIBBEY PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3100
Practice Address - Country:US
Practice Address - Phone:781-335-3900
Practice Address - Fax:781-337-9424
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA474032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC27097Medicare ID - Type Unspecified
MAA53964Medicare UPIN