Healthcare Provider Details

I. General information

NPI: 1558344879
Provider Name (Legal Business Name): THOMAS W LEVREAULT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BELMONT ST
WORCESTER MA
01605-2903
US

IV. Provider business mailing address

119 BELMONT ST
WORCESTER MA
01605-2903
US

V. Phone/Fax

Practice location:
  • Phone: 508-334-6491
  • Fax: 508-334-8488
Mailing address:
  • Phone: 508-334-6491
  • Fax: 508-334-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number55529
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: