MEDICARE: ONEIDA H LEVINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2489	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0428Y	OTHER	NC	BCBS INDIVIDUAL

General Provider Information

NPI Number	:	1407822885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ONEIDA H LEVINE

Provider Business Mailing Address
First Line	:	1710 COUNTRY CLUB RD
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4838
Country	:	US
Telephone Number	:	919-738-4649
Fax Number	:	252-726-8403

Provider Business Practice Location Address
First Line	:	1710 COUNTRY CLUB RD
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-4838
Country	:	US
Telephone Number	:	919-738-4649
Fax Number	:	252-726-8403

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	03/20/2008

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Directions to “ ONEIDA H LEVINE ” Practice Location

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