Healthcare Provider Details

I. General information

NPI: 1003801606
Provider Name (Legal Business Name): FREDERIC EVAN LEVY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 ABERDEEN BLVD
GASTONIA NC
28054-0635
US

IV. Provider business mailing address

2520 ABERDEEN BLVD
GASTONIA NC
28054-0635
US

V. Phone/Fax

Practice location:
  • Phone: 704-868-8400
  • Fax: 704-868-8493
Mailing address:
  • Phone: 704-868-8400
  • Fax: 704-868-8493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number94-00559
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number9400559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: