Provider Demographics
NPI:1063413979
Name:LEVITAN, MELANIE R (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:R
Last Name:LEVITAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 30
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230
Mailing Address - Country:US
Mailing Address - Phone:413-528-9311
Mailing Address - Fax:413-644-0274
Practice Address - Street 1:CHP - LEE FAMILY PRACTICE
Practice Address - Street 2:11 QUARRY HILL ROAD
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238
Practice Address - Country:US
Practice Address - Phone:413-243-0536
Practice Address - Fax:413-243-8040
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57045207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3067734Medicaid
MAJ10756OtherBCBS
MA110048888AMedicaid
MA768309OtherTUFTS
MA768309OtherTUFTS
MA110048888AMedicaid