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NPI Code Detail

MEDICARE: DR. EDWARD RAPHAEL LEVY MD

MEDICARE: DR. EDWARD RAPHAEL LEVY MD
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
12080A0000XPediatric Adolescent Medicine Physician77208MA

General Provider Information

NPI Number : 1255309571
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EDWARD RAPHAEL LEVY MD
Provider Business Mailing Address
First Line : 500 COLUMBIA RD
Second Line : 415-03
City : DORCHESTER
State : MA
Zip : 02125-2322
Country : US
Telephone Number : 617-287-8000
Fax Number :
Provider Business Practice Location Address
First Line : 500 COLUMBIA RD
Second Line : MAILSTOP 415-03
City : DORCHESTER
State : MA
Zip : 02125-2322
Country : US
Telephone Number : 617-287-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2006
Last Update Date : 07/08/2007

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