Provider Demographics
NPI:1528024643
Name:LEVINE, STEPHEN JOHN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JOHN
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1221 MAIN ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-5396
Mailing Address - Country:US
Mailing Address - Phone:413-536-5525
Mailing Address - Fax:413-533-4084
Practice Address - Street 1:1221 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-5396
Practice Address - Country:US
Practice Address - Phone:413-536-5525
Practice Address - Fax:413-533-4084
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2010-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA35906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6168833Medicaid
MA04-2801718OtherFEDERAL ID NUMBER
MAB75906Medicare UPIN
MAMO 8915Medicare ID - Type Unspecified