Provider Demographics
NPI:1366420259
Name:LEVY, ROBERT DREW (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DREW
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:55 GOULD RD
Mailing Address - Street 2:
Mailing Address - City:WABAN
Mailing Address - State:MA
Mailing Address - Zip Code:02468-2142
Mailing Address - Country:US
Mailing Address - Phone:617-964-0112
Mailing Address - Fax:617-527-5469
Practice Address - Street 1:50 DERBY ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3740
Practice Address - Country:US
Practice Address - Phone:781-740-0403
Practice Address - Fax:617-527-5469
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA356822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B72641Medicare UPIN