Provider Demographics
NPI:1164412581
Name:LEVY, ARDEN LYNN (M D)
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:LYNN
Last Name:LEVY
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 MOORE DUNCAN HWY
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:SC
Mailing Address - Zip Code:29369-9414
Mailing Address - Country:US
Mailing Address - Phone:864-585-5552
Mailing Address - Fax:864-597-0179
Practice Address - Street 1:98 WILLOW LN
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1357
Practice Address - Country:US
Practice Address - Phone:864-585-5552
Practice Address - Fax:864-597-0179
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17675207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC176758Medicaid
F97203Medicare UPIN