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General NPI Number Information
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NPI Number | 1396936399
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Entity Type | Individual
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Provider Name | FREDRIC E LEVISON M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 08/05/2007
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Provider Practice Location Address
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Address Line | 212 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6825
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Country | US
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Telephone | 508-255-0879
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Fax |
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Provider Business Mailing Address
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Address Line | 40 CRANBERRY LN
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City | EASTHAM
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State | MA
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Zip | 02642-2338
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Country | US
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Telephone | 508-255-0879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 30246
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License Number State | MA
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