Provider Demographics
NPI:1558377051
Name:LEBWOHL, DAVID J (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:LEBWOHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:77 HERRICK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-3012
Mailing Address - Country:US
Mailing Address - Phone:978-927-4110
Mailing Address - Fax:978-232-7057
Practice Address - Street 1:77 HERRICK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-3012
Practice Address - Country:US
Practice Address - Phone:978-927-4110
Practice Address - Fax:978-232-7057
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA40140207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2051915Medicaid
D03103Medicare ID - Type Unspecified
A54011Medicare UPIN