Basic Information
Provider Information | |||||||||
NPI: | 1710987607 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LEVINE | ||||||||
FirstName: | MARILYN | ||||||||
MiddleName: | L | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 260 NEW LUDLOW RD | ||||||||
Address2: | WESTERN MASS PHYSICIAN ASSOCIATES, INC. | ||||||||
City: | CHICOPEE | ||||||||
State: | MA | ||||||||
PostalCode: | 010204324 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135333470 | ||||||||
FaxNumber: | 4135336859 | ||||||||
Practice Location | |||||||||
Address1: | 2 HOSPITAL DR STE 101 | ||||||||
Address2: | D/B/A: HOLYOKE ASSOCIATES IN INTERNAL MEDICINE | ||||||||
City: | HOLYOKE | ||||||||
State: | MA | ||||||||
PostalCode: | 010406616 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4135368924 | ||||||||
FaxNumber: | 4135329141 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/21/2005 | ||||||||
LastUpdateDate: | 01/21/2008 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 33365 | MA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RH0000X | 33365 | MA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
ID | Type | State | Issuer | Description | 2003708 | 05 | MA |   | MEDICAID | 100070 | 01 |   | CIGNA | OTHER | G10005 | 01 |   | HMO BLUE | OTHER | 033365 | 01 |   | TUFTS | OTHER | 000000007941 | 01 |   | BOSTON MEDICAL CENTER-HNP | OTHER | 2003708 | 01 | MA | MEDICAID - PCC | OTHER | 13900 | 01 |   | HEALTH NEW ENGLAND | OTHER | 981296 | 01 |   | NETWORK HEALTH | OTHER | 0003029 | 01 |   | NEIGHBORHOOD HEALTH PLAN | OTHER | G10005 | 01 |   | BLUECARE 65 | OTHER | 66448 | 01 |   | HARVARD PILGRIM | OTHER |