Provider Demographics
NPI:1861518326
Name:LEVY, JOSHUA M (RD)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:M
Last Name:LEVY
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W TISBURY RD
Mailing Address - Street 2:
Mailing Address - City:EDGARTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02539-7183
Mailing Address - Country:US
Mailing Address - Phone:508-627-3235
Mailing Address - Fax:508-627-7270
Practice Address - Street 1:256 EDGARTOWN VINEYARD HAVEN RD
Practice Address - Street 2:
Practice Address - City:EDGARTOWN
Practice Address - State:MA
Practice Address - Zip Code:02539-6933
Practice Address - Country:US
Practice Address - Phone:508-627-3235
Practice Address - Fax:508-627-7270
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3260133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
016349OtherKAISER-COMMERCIAL NUMBER
016349OtherKAISER-COMMERCIAL NUMBER