Provider Demographics
NPI:1336127521
Name:ANSALDO, LEVY D (MD)
Entity Type:Individual
Prefix:
First Name:LEVY
Middle Name:D
Last Name:ANSALDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-6232
Mailing Address - Country:US
Mailing Address - Phone:508-996-2553
Mailing Address - Fax:508-990-7558
Practice Address - Street 1:874 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-6232
Practice Address - Country:US
Practice Address - Phone:508-996-2553
Practice Address - Fax:508-990-7558
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78638207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0554812OtherAETNA
MAJ14341OtherBCBS
MA078638OtherTUFTS
RI20527-0OtherBCRI
MA65698OtherHARVARD PILGRIM
MAB5064998001OtherCIGNA
MA000000024028OtherBMC
RI404018OtherBLUECHIP
MAMA0030390OtherTRICARE
MA0003182OtherNHP
MA3146669Medicaid
MA0400788OtherUNITED HEALTH
RI20527-0OtherBCRI
MA3146669Medicaid