Healthcare Provider Details

I. General information

NPI: 1366420259
Provider Name (Legal Business Name): ROBERT DREW LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DERBY ST
HINGHAM MA
02043-3740
US

IV. Provider business mailing address

55 GOULD RD
WABAN MA
02468-2142
US

V. Phone/Fax

Practice location:
  • Phone: 781-740-0403
  • Fax: 617-527-5469
Mailing address:
  • Phone: 617-964-0112
  • Fax: 617-527-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35682
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: