Provider Demographics
NPI:1346225943
Name:LEVY, PAUL FREDRIC (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:FREDRIC
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 1:600 HOSPITAL DR
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8024
Mailing Address - Country:US
Mailing Address - Phone:828-452-0331
Mailing Address - Fax:828-456-6100
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8024
Practice Address - Country:US
Practice Address - Phone:828-452-0331
Practice Address - Fax:828-456-6100
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030049E207RG0100X
NC2015-02400207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011078700006Medicaid
PA138118ES4Medicare PIN
PAC31452Medicare UPIN