Provider Demographics
NPI:1407858913
Name:LEVINE, MITCHELL J (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:J
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-0086
Mailing Address - Country:US
Mailing Address - Phone:781-749-9071
Mailing Address - Fax:781-749-2133
Practice Address - Street 1:186 ALEWIFE BROOK PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1121
Practice Address - Country:US
Practice Address - Phone:617-441-5550
Practice Address - Fax:617-441-5552
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA46996207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6168477Medicaid
MA6168477Medicaid
MAC46392Medicare UPIN