Provider Demographics
NPI:1932411949
Name:LEVITT, MARA LAUREN (MD)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:LAUREN
Last Name:LEVITT
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 1:1028 LEE ANN DR NE STE 200
Mailing Address - Street 2:EMERGENCY MEDICINE
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2915
Mailing Address - Country:US
Mailing Address - Phone:704-782-1892
Mailing Address - Fax:
Practice Address - Street 1:1028 LEE ANN DR NE STE 200
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2915
Practice Address - Country:US
Practice Address - Phone:704-782-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-07
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL32644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine