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General NPI Number Information
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NPI Number | 1588685671
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Entity Type | Individual
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Provider Name | DMITRY LEVENSON MD
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Gender | Male
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 344 THOMPSON RD
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City | WEBSTER
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State | MA
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Zip | 01570-1509
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Country | US
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Telephone | 508-671-4050
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Fax | 508-949-6742
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Provider Business Mailing Address
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Address Line | 630 PLANTATION ST
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City | WORCESTER
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State | MA
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Zip | 01605-2038
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Country | US
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Telephone | 508-368-5529
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 054922
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License Number State | GA
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