Provider Demographics
NPI:1710987607
Name:LEVINE, MARILYN L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:L
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:260 NEW LUDLOW RD
Mailing Address - Street 2:WESTERN MASS PHYSICIAN ASSOCIATES, INC.
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-4324
Mailing Address - Country:US
Mailing Address - Phone:413-533-3470
Mailing Address - Fax:413-533-6859
Practice Address - Street 1:2 HOSPITAL DR STE 101
Practice Address - Street 2:D/B/A: HOLYOKE ASSOCIATES IN INTERNAL MEDICINE
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-6616
Practice Address - Country:US
Practice Address - Phone:413-536-8924
Practice Address - Fax:413-532-9141
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2008-01-21
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Provider Licenses
StateLicense IDTaxonomies
MA33365207R00000X, 207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2003708Medicaid
100070OtherCIGNA
G10005OtherHMO BLUE
033365OtherTUFTS
000000007941OtherBOSTON MEDICAL CENTER-HNP
MA2003708OtherMEDICAID - PCC
13900OtherHEALTH NEW ENGLAND
981296OtherNETWORK HEALTH
0003029OtherNEIGHBORHOOD HEALTH PLAN
G10005OtherBLUECARE 65
66448OtherHARVARD PILGRIM
G10005OtherBLUECARE 65
033365OtherTUFTS