Provider Demographics
NPI:1003801606
Name:LEVY, FREDERIC EVAN (MD)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:EVAN
Last Name:LEVY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 ABERDEEN BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0635
Mailing Address - Country:US
Mailing Address - Phone:704-868-8400
Mailing Address - Fax:704-868-8493
Practice Address - Street 1:2520 ABERDEEN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0635
Practice Address - Country:US
Practice Address - Phone:704-868-8400
Practice Address - Fax:704-868-8493
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-00559174400000X
NC9400559207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5177XOtherBLUE CROSS BLUE SHIELD
NC72586OtherMEDCOST
SCN00559OtherSOUTH CAROLINA MEDICAID
NC2084887005OtherCIGNA HEALTHCARE
NC10-41162OtherUNITED HEALTHCARE
NC11536OtherPARTNERS HEALTHPLAN
NC2031685OtherAETNA HEALTHPLAN
NC2103800OtherMAMSI
NC343002OtherCOVENTRY HEALTHCARE
NC895177XMedicaid
040008664OtherRAILROAD MEDICARE
NC168235OtherMIDSOUTH
NC895177XMedicaid