Provider Demographics
NPI:1760592281
Name:LEVINE, MITCHELL IRA (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:IRA
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2000 WASHINGTON ST
Mailing Address - Street 2:SUITE 546
Mailing Address - City:NEWTON LOWER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1650
Mailing Address - Country:US
Mailing Address - Phone:617-964-5020
Mailing Address - Fax:617-964-3033
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:SUITE 546
Practice Address - City:NEWTON LOWER FALLS
Practice Address - State:MA
Practice Address - Zip Code:02462-1650
Practice Address - Country:US
Practice Address - Phone:617-964-5020
Practice Address - Fax:617-964-3033
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49243207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA049243OtherTUFTS HEALTH PLAN
MA64271OtherHARVARD PILGRIM HEALTHCAR
MA0402222OtherUNITED HEALTHCARE
MA110045881OtherRAILROAD MEDICARE
MAJ08391OtherBLUE SHIELD
MA3047822Medicaid
MAB10419201OtherCIGNA HEALTHCARE
MAB10419201OtherCIGNA HEALTHCARE
MAJ08391OtherBLUE SHIELD
CX2690Medicare PIN