Basic Information
| Provider Information | |||||||||
| NPI: | 1164469714 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEBOVITS | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 845706 | ||||||||
| Address2: | PARK ANESTHESIA | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022845706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007201664 | ||||||||
| FaxNumber: | 2077532020 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 PARK ST | ||||||||
| Address2: | ANESTHESIA DEPARTMENT | ||||||||
| City: | ATTLEBORO | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027033143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5082367430 | ||||||||
| FaxNumber: | 5082367446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 10/26/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 80458 | MA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 80458 | MA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3135551 | 05 | MA | MEDICAID |