Basic Information
| Provider Information | |||||||||
| NPI: | 1861469785 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEAVITT | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | I. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 MOUNT AUBURN ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174971560 | ||||||||
| FaxNumber: | 6174971109 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 MOUNT AUBURN ST | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021385600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174971560 | ||||||||
| FaxNumber: | 6174971109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 04/14/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 60344 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | J25105 | 01 | MA | BCBS | OTHER | 0190942 | 05 | MA | MEDICAID | 060344 | 01 | MA | TUFTS | OTHER | 1861469785 | 01 | MA | BOSTON MEDICAL CENTER HEALTH NET PLAN | OTHER | 2901140 | 01 | MA | AETNA HEALTH PLAN | OTHER | 0018444 | 01 | MA | NEIGHBORHOOD HEALTH PLAN | OTHER | 59300 | 01 | MA | FALLON HEALTH PLAN | OTHER | 2295706 | 01 | MA | CIGNA HEALTH PLAN | OTHER | 304187 | 01 | MA | HARVARD PILGRIM HEALTH PLAN | OTHER | 97526602 | 01 | MA | NETWORK HEALTH PLAN | OTHER |