Provider Demographics
NPI:1477843399
Name:WILLARD, DEVINA LUHUR (MD)
Entity Type:Individual
Prefix:
First Name:DEVINA
Middle Name:LUHUR
Last Name:WILLARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEVINA
Other - Middle Name:
Other - Last Name:LUHUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:143 LONGWATER DR.
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061
Mailing Address - Country:US
Mailing Address - Phone:781-878-5200
Mailing Address - Fax:
Practice Address - Street 1:143 LONGWATER DR.
Practice Address - Street 2:
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061
Practice Address - Country:US
Practice Address - Phone:781-878-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA248473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
04-2297845OtherUNITED HEALTH CARE
0710068OtherCIGNA
LA110097270AMedicaid
5337820OtherAETNA
04-2297845OtherGIC-UNICARE
198381OtherTUFTS AND TMP
04-2297845OtherMULTI-PLAN, PHCS
04-2297845OtherTRICARE
1477843399OtherNEIGHBORHOOD HEALTH CARD
AA500531OtherHARVARD PILGRIM
MAS400328036Medicare PIN