Provider Demographics
NPI:1285734293
Name:LEVATIN, JANET LYNN (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LYNN
Last Name:LEVATIN
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 1:1101 BEACON STREET
Mailing Address - Street 2:SUITE 5E
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5587
Mailing Address - Country:US
Mailing Address - Phone:617-738-4600
Mailing Address - Fax:
Practice Address - Street 1:1101 BEACON STREET
Practice Address - Street 2:SUITE 5E
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5587
Practice Address - Country:US
Practice Address - Phone:617-738-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA55155208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3013120Medicaid
MAV0297337Medicare ID - Type Unspecified
MA3013120Medicaid