Provider Demographics
NPI:1386752921
Name:LLEWELLYN, EARLINE (MD)
Entity type:Individual
Prefix:DR
First Name:EARLINE
Middle Name:
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EARLINE
Other - Middle Name:
Other - Last Name:LLEWELLYN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:95 WENDY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-3404
Mailing Address - Country:US
Mailing Address - Phone:508-222-3200
Mailing Address - Fax:508-222-7034
Practice Address - Street 1:687 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1518
Practice Address - Country:US
Practice Address - Phone:508-222-3200
Practice Address - Fax:508-222-7034
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59644207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3036880Medicaid
MAE01909Medicare UPIN
MAJ07772Medicare Oscar/Certification