Provider Demographics
NPI:1417041781
Name:LEVIN, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:LEVIN
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 1:2000 WASHINGTON ST
Mailing Address - Street 2:STE 445
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1608
Mailing Address - Country:US
Mailing Address - Phone:617-965-1118
Mailing Address - Fax:617-965-6547
Practice Address - Street 1:2000 WASHINGTON ST
Practice Address - Street 2:STE 445
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1608
Practice Address - Country:US
Practice Address - Phone:617-965-1118
Practice Address - Fax:617-965-6547
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA42133207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB33568Medicare PIN
B73020Medicare UPIN