Provider Demographics
NPI:1720190051
Name:LEFEVRE, MARIE EDITH F (MD)
Entity Type:Individual
Prefix:
First Name:MARIE EDITH
Middle Name:F
Last Name:LEFEVRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIE EDITH
Other - Middle Name:FAUBLAS
Other - Last Name:LEFEVRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3101 CLARENDON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226
Mailing Address - Country:US
Mailing Address - Phone:718-462-6611
Mailing Address - Fax:718-462-4944
Practice Address - Street 1:3101 CLARENDON RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226
Practice Address - Country:US
Practice Address - Phone:718-462-6611
Practice Address - Fax:718-462-4944
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155114208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00830566Medicaid
NY00830566Medicaid
D46700Medicare UPIN