Provider Demographics
NPI:1740271873
Name:LESKOWITZ, ERIC DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:LESKOWITZ
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Gender:M
Credentials:MD
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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:617-573-2622
Mailing Address - Fax:617-573-2489
Practice Address - Street 1:125 NASHUA ST
Practice Address - Street 2:SRH SPAULDING REHAB HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1198
Practice Address - Country:US
Practice Address - Phone:617-573-2622
Practice Address - Fax:617-573-2489
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-07-24
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Provider Licenses
StateLicense IDTaxonomies
MA511272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3064310Medicaid
MA716146OtherTUFTS HEALTH PLAN
MAJ02576OtherBCBS MA
MA3064310Medicaid
MA716146OtherTUFTS HEALTH PLAN