Provider Demographics
NPI:1396739256
Name:HARVEY, DAVID LESLIE (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LESLIE
Last Name:HARVEY
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 1:1899 TATE BLVD SE
Mailing Address - Street 2:SUITE 2101
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-4200
Mailing Address - Country:US
Mailing Address - Phone:828-327-7788
Mailing Address - Fax:828-327-0112
Practice Address - Street 1:1899 TATE BLVD SE
Practice Address - Street 2:SUITE 2101
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-4200
Practice Address - Country:US
Practice Address - Phone:828-327-7788
Practice Address - Fax:282-327-0112
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32718174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940515Medicaid
NCC76945Medicare UPIN
NC8940515Medicaid