Provider Demographics
NPI:1760423966
Name:LEVINE, DEBORAH (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:LEVINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:L
Other - Last Name:JESURUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:147 SHERBURN CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:MA
Mailing Address - Zip Code:02493-1049
Mailing Address - Country:US
Mailing Address - Phone:781-235-1697
Mailing Address - Fax:
Practice Address - Street 1:330 BROOKLINE AVE
Practice Address - Street 2:BETH ISRAEL DEACONESS MEDICAL CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5491
Practice Address - Country:US
Practice Address - Phone:617-667-8901
Practice Address - Fax:617-667-8212
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA795422085R0202X
CAG669722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3128474Medicaid
MAB20271101OtherCIGAN/HEALTHSOURCE HMO1
MA300111897OtherRAILROAD MEDICARE
MA4509267OtherAETNA NONHMO
MA16-00623OtherUNITED DIRECT ACCESS2
MA0487897OtherAETNA HMO1
MA3580927-001OtherDIGNA PAL 1
MD70010000J30678OtherBLUE CROSS
MA079542OtherSECURE HORIZONS, TUFTS
MAF64452BIOtherHARVARD PILGRIM
MA2186722OtherAETNA HMO2
MA39754OtherFALLON
MA16-01485OtherEVERCARE
MA989793OtherNETWORK HEALTH
MA16-40213OtherUNITED DIRECT ACCESS 1
MAB20271101OtherCIGAN/HEALTHSOURCE HMO1