Provider Demographics
NPI:1376554923
Name:LEVHEIM, LISA M (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:LEVHEIM
Suffix:
Gender:F
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:PO BOX 313
Mailing Address - Street 2:
Mailing Address - City:LEEDS
Mailing Address - State:MA
Mailing Address - Zip Code:01053-0313
Mailing Address - Country:US
Mailing Address - Phone:413-727-3901
Mailing Address - Fax:413-727-3902
Practice Address - Street 1:38 MULBERRY ST STE 204
Practice Address - Street 2:
Practice Address - City:LEEDS
Practice Address - State:MA
Practice Address - Zip Code:01053-5339
Practice Address - Country:US
Practice Address - Phone:413-727-3901
Practice Address - Fax:413-727-3902
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3066851Medicaid
E65672Medicare UPIN
J10247Medicare ID - Type Unspecified