Basic Information
Provider Information
NPI: 1518934405
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEVITIN
FirstName: DAVID
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 630 PLANTATION ST
Address2:  
City: WORCESTER
State: MA
PostalCode: 01605
CountryCode: US
TelephoneNumber: 5088710700
FaxNumber: 5086164411
Practice Location
Address1: 106 E MAIN ST
Address2:  
City: WESTBOROUGH
State: MA
PostalCode: 01581
CountryCode: US
TelephoneNumber: 5088710700
FaxNumber: 5086164411
Other Information
ProviderEnumerationDate: 03/01/2006
LastUpdateDate: 02/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X40863MAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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