Provider Demographics
NPI:1245209840
Name:LEVY, SANFORD M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:M
Last Name:LEVY
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 1:6 ESSEX CENTER DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2910
Mailing Address - Country:US
Mailing Address - Phone:978-532-8010
Mailing Address - Fax:978-532-5147
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:SUITE 307
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2910
Practice Address - Country:US
Practice Address - Phone:978-532-8010
Practice Address - Fax:978-532-5147
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA318632084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2028646Medicaid
MA2028646Medicaid
MAB33276Medicare ID - Type Unspecified
MADX0256Medicare PIN