Basic Information
| Provider Information | |||||||||
| NPI: | 1003801606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVY | ||||||||
| FirstName: | FREDERIC | ||||||||
| MiddleName: | EVAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2520 ABERDEEN BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280540635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048688400 | ||||||||
| FaxNumber: | 7048688493 | ||||||||
| Practice Location | |||||||||
| Address1: | 2520 ABERDEEN BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280540635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048688400 | ||||||||
| FaxNumber: | 7048688493 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2005 | ||||||||
| LastUpdateDate: | 07/08/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 94-00559 | NC | N | Other Service Providers | Specialist | 207Y00000X | 9400559 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 5177X | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 72586 | 01 | NC | MEDCOST | OTHER | N00559 | 01 | SC | SOUTH CAROLINA MEDICAID | OTHER | 2084887005 | 01 | NC | CIGNA HEALTHCARE | OTHER | 10-41162 | 01 | NC | UNITED HEALTHCARE | OTHER | 11536 | 01 | NC | PARTNERS HEALTHPLAN | OTHER | 2031685 | 01 | NC | AETNA HEALTHPLAN | OTHER | 2103800 | 01 | NC | MAMSI | OTHER | 343002 | 01 | NC | COVENTRY HEALTHCARE | OTHER | 895177X | 05 | NC | MEDICAID | 040008664 | 01 | RAILROAD MEDICARE | OTHER | 168235 | 01 | NC | MIDSOUTH | OTHER |