MEDICARE: BRENDA F. LEVY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	286364	MA

General Provider Information

NPI Number	:	1053639765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA F. LEVY MD

Provider Business Mailing Address
First Line	:	4199 WASHINGTON ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4199 WASHINGTON ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-1733
Country	:	US
Telephone Number	:	617-323-4440
Fax Number	:	617-323-7870

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2010
Last Update Date	:	03/24/2021

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