Healthcare Provider Details

I. General information

NPI: 1063953164
Provider Name (Legal Business Name): MICHAEL LEVASSEUR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 WASHINGTON ST
TAUNTON MA
02780-2465
US

IV. Provider business mailing address

PO BOX 417379
BOSTON MA
02241-7379
US

V. Phone/Fax

Practice location:
  • Phone: 781-280-1695
  • Fax: 781-276-6410
Mailing address:
  • Phone: 781-280-1695
  • Fax: 781-276-6410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA6141
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5059
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: