Provider Demographics
NPI:1477588531
Name:LEVITZKY, YAMINI S (MD)
Entity Type:Individual
Prefix:
First Name:YAMINI
Middle Name:S
Last Name:LEVITZKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:147 MILK STREET
Mailing Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:617-421-6540
Mailing Address - Fax:
Practice Address - Street 1:111 GROSSMAN DRIVE
Practice Address - Street 2:HARVARD VANGUARD MEDICAL ASSOCIATES
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184
Practice Address - Country:US
Practice Address - Phone:781-849-2274
Practice Address - Fax:781-849-1000
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA221350207R00000X, 208M00000X
OH35-087985207R00000X
MA221360207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0036804OtherNEIGHBORHOOD HEALTH
MA2113431Medicaid
MAAA46568OtherHARVARD PILGRIM
MAJ29564OtherBLUE CROSS
MA494384OtherTUFTS
MA494384OtherTUFTS
MAJ29564OtherBLUE CROSS