Provider Demographics
NPI:1962492033
Name:LEV, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:LEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-8321
Mailing Address - Fax:617-724-3338
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:NEURORADIOLOGY GRB 241H
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-7125
Practice Address - Fax:617-724-3338
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA59372207R00000X, 2085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3121569Medicaid
MA735978OtherTUFTS HEALTH PLAN
MAJ14493OtherBCBS MA
MAJ14493OtherBCBS MA
MA735978OtherTUFTS HEALTH PLAN