Healthcare Provider Details

I. General information

NPI: 1205911914
Provider Name (Legal Business Name): KEITH C LEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 CEDAR ST
WORCESTER MA
01609
US

IV. Provider business mailing address

52 CEDAR ST
WORCESTER MA
01609
US

V. Phone/Fax

Practice location:
  • Phone: 508-752-5191
  • Fax: 508-792-1514
Mailing address:
  • Phone: 508-752-5191
  • Fax: 508-792-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number40136
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: