Provider Demographics
NPI:1083685754
Name:LEVIN, LAURA ANN (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:LEVIN
Suffix:
Gender:F
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1085 NE GATEWAY CT NE
Practice Address - Street 2:STE 290
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2406
Practice Address - Country:US
Practice Address - Phone:704-403-4650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94008962084A0401X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC160720OtherWELLPATH
NC895176EMedicaid
NC5176EOtherBCBS
NC51786OtherMEDCOST
NC20-8776473OtherPRACTICE TAX ID
NC4516316OtherAETNA
NC16382OtherPARTNERS MEDICARE CHOICE
NC844282OtherMAMSI
NC51786OtherMEDCOST