Basic Information
| Provider Information | |||||||||
| NPI: | 1114047263 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVITRE | ||||||||
| FirstName: | RAYMOND | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 81 LIBERTY SQUARE RD APT 34B | ||||||||
| Address2: | |||||||||
| City: | BOXBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017191634 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 30 WARREN ST | ||||||||
| Address2: | |||||||||
| City: | BRIGHTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021353602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172543800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 283XC2000X | 6491 | MA | Y | Hospitals | Rehabilitation Hospital | Children |
No ID Information.