Healthcare Provider Details

I. General information

NPI: 1053639765
Provider Name (Legal Business Name): BRENDA F. LEVY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2010
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 WASHINGTON ST
ROSLINDALE MA
02131-1733
US

IV. Provider business mailing address

4199 WASHINGTON ST
ROSLINDALE MA
02131-1733
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-4440
  • Fax: 617-323-7870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number286364
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: