Healthcare Provider Details

I. General information

NPI: 1255488102
Provider Name (Legal Business Name): HERBERT H LEVENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAHEY CLINIC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

IV. Provider business mailing address

LAHEY CLINIC 41 MALL ROAD
BURLINGTON MA
01805-0001
US

V. Phone/Fax

Practice location:
  • Phone: 978-534-4120
  • Fax: 978-538-4702
Mailing address:
  • Phone: 978-534-4120
  • Fax: 978-538-4702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number29365
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: