Provider Demographics
NPI:1740393222
Name:LEVITAN, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:LEVITAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:181 WELLS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3344
Mailing Address - Country:US
Mailing Address - Phone:617-934-6400
Mailing Address - Fax:617-934-6401
Practice Address - Street 1:181 WELLS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-3344
Practice Address - Country:US
Practice Address - Phone:617-934-6400
Practice Address - Fax:617-934-6401
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2015-11-19
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Provider Licenses
StateLicense IDTaxonomies
MA222719207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ40331OtherBCBS OF MA
MAAA65576OtherHARVARD PILGRIM
MA479166OtherTUFTS HEALTH PLAN