Provider Demographics
NPI:1861687956
Name:LEVINE, DAVID WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAM
Last Name:LEVINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 CAMBRIDGE PKWY
Mailing Address - Street 2:GENZYME - 3RD FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02142-1234
Mailing Address - Country:US
Mailing Address - Phone:617-761-8405
Mailing Address - Fax:617-761-8411
Practice Address - Street 1:55 CAMBRIDGE PKWY
Practice Address - Street 2:GENZYME - 3RD FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02142-1234
Practice Address - Country:US
Practice Address - Phone:617-761-8405
Practice Address - Fax:617-761-8411
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59283207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAE68110Medicare UPIN