Provider Demographics
NPI:1275679516
Name:LEV, IAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:MICHAEL
Last Name:LEV
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 1:5540 CENTERVIEW DR
Mailing Address - Street 2:SUITE 423
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-3369
Mailing Address - Country:US
Mailing Address - Phone:919-859-1014
Mailing Address - Fax:
Practice Address - Street 1:5540 CENTERVIEW DR
Practice Address - Street 2:SUITE 423
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27606-3369
Practice Address - Country:US
Practice Address - Phone:919-859-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC206162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8951768Medicaid
F13143Medicare UPIN
NC8951768Medicaid