Provider Demographics
NPI:1417258211
Name:LEVINE, DOUGLAS STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:STEWART
Last Name:LEVINE
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 1:301 BINNEY ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1030
Mailing Address - Country:US
Mailing Address - Phone:617-374-3906
Mailing Address - Fax:617-494-0480
Practice Address - Street 1:301 BINNEY ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1030
Practice Address - Country:US
Practice Address - Phone:617-374-3906
Practice Address - Fax:617-494-0480
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062687L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist