Provider Demographics
NPI:1003895954
Name:LEVY, JAY BERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:BERRY
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:PO BOX 602148
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2148
Mailing Address - Country:US
Mailing Address - Phone:704-381-3510
Mailing Address - Fax:704-540-3668
Practice Address - Street 1:3125 SPRINGBANK LN
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-3378
Practice Address - Country:US
Practice Address - Phone:704-381-3510
Practice Address - Fax:704-540-3668
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600282174400000X, 2088P0231X
SC184832088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00282Medicaid
NC8951818Medicaid
NC1003895954Medicaid
SC5953113OtherAETNA
SC63276OtherMEDCOST