Provider Demographics
NPI:1427250695
Name:LINDA H. LEAVENWORTH, M.D., P.C.
Entity type:Organization
Organization Name:LINDA H. LEAVENWORTH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEAVENWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-635-0477
Mailing Address - Street 1:411 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720
Mailing Address - Country:US
Mailing Address - Phone:978-635-0477
Mailing Address - Fax:
Practice Address - Street 1:411 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-3739
Practice Address - Country:US
Practice Address - Phone:978-635-0477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56101207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06513OtherBCBS INDIVDUAL PROVIDER #
MA1938517OtherCIGNA PROVIDER ID#
MA056101OtherTUFTS PROVIDER #
MA3023311Medicaid
MD2018428OtherAETNA PROVIDER #
MA0700573OtherUNITED HEALTHCARE ID#
MA13614OtherHPHC PROVIDER#
MAM16905OtherBCBS OF MA GRP#
MA7166OtherFALLON PROVIDER ID#
MAA59142Medicare UPIN
MAJ06513OtherBCBS INDIVDUAL PROVIDER #