Provider Demographics
NPI:1154389278
Name:LEVY, JASON A (MD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:CHILDREN'S HOSPITAL BOSTON, CB0120
Mailing Address - Street 2:300 LONGWOOD AVE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6624
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6624
Practice Address - Fax:617-730-0335
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2015-04-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA213723208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2024250Medicaid
I04189Medicare UPIN
A36642Medicare ID - Type Unspecified