MEDICARE: DR. LINDA H LEAVENWORTH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	56101	MA
2	207VG0400X	Gynecology Physician	56101	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	056101	OTHER	MA	TUFTS HEALTH PLAN
2	2018428	OTHER	MA	AETNA INSURANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	82830	OTHER	MD	FALLON INSURANCE
5	13614	OTHER	MD	HARVARD PILGRIM HEALTH
6	J06513	OTHER	MA	BLUE CROSS & BLUE SHIELD

General Provider Information

NPI Number	:	1053311076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA H LEAVENWORTH M.D.

Provider Business Mailing Address
First Line	:	411 MASSACHUSETTS AVE
Second Line	:	SUITE 202
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-635-0477
Fax Number	:

Provider Business Practice Location Address
First Line	:	411 MASSACHUSETTS AVE
Second Line	:	SUITE 202
City	:	ACTON
State	:	MA
Zip	:	01720-3739
Country	:	US
Telephone Number	:	978-635-0477
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	08/15/2012

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Directions to “ DR. LINDA H LEAVENWORTH M.D.” Practice Location

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