Provider Demographics
NPI:1801999230
Name:LEVY, BRUCE FARRELL (MD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:FARRELL
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:90 TER HEUN DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2533
Mailing Address - Country:US
Mailing Address - Phone:508-540-0604
Mailing Address - Fax:508-457-0129
Practice Address - Street 1:90 TER HEUN DR
Practice Address - Street 2:SUITE 300
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2533
Practice Address - Country:US
Practice Address - Phone:508-540-0604
Practice Address - Fax:508-457-0129
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2009-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA41230207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2289161OtherAETNA
MA1801999230OtherUNICARE
MA000000029655OtherBOSTON MEDICAL CENTER
MA060058501OtherMEDICARE ID
MAB20488202OtherCIGNA
MA060058501OtherTRICARE
MA1801999230OtherNETWORK HEALTH
MA1801999230OtherGREAT WEST HEALTHCARE
MA708221OtherTUFTS HEALTH PLAN
MA0170305Medicaid
MA11545062OtherCAQH
MA25-00643OtherUNITED HEALTHCARE
3127OtherHARVARD PILGRIM
MAL07184OtherBLUE CROSS BLUE SHIELD
MA000000029655OtherBOSTON MEDICAL CENTER
MA11545062OtherCAQH