Provider Demographics
NPI:1457392714
Name:LEVITZKY, BENJAMIN E (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:E
Last Name:LEVITZKY
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 STE 368
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-1627
Mailing Address - Country:US
Mailing Address - Phone:617-969-1227
Mailing Address - Fax:617-969-2676
Practice Address - Street 1:2000 WASHINGTON ST STE 368
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02462-1627
Practice Address - Country:US
Practice Address - Phone:617-969-1227
Practice Address - Fax:617-969-2676
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA222858207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2101190Medicaid
MAA38277Medicare ID - Type Unspecified
I27960Medicare UPIN