Provider Demographics
NPI:1376521476
Name:LITVIN, YIGAL SAMUEL (MD)
Entity Type:Individual
Prefix:
First Name:YIGAL
Middle Name:SAMUEL
Last Name:LITVIN
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 1:41 WAHCONAH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-2627
Mailing Address - Country:US
Mailing Address - Phone:413-447-2375
Mailing Address - Fax:732-963-9092
Practice Address - Street 1:41 WAHCONAH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-2627
Practice Address - Country:US
Practice Address - Phone:413-447-2375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05613800208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ048 0703Medicaid
NJ340004305Medicare PIN
NJ048 0703Medicaid
664731AGVMedicare PIN