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General NPI Number Information
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NPI Number | 1003895954
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Entity Type | Individual
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Provider Name | JAY BERRY LEVY M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 3125 SPRINGBANK LN SUITE E
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City | CHARLOTTE
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State | NC
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Zip | 28226-3378
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Country | US
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Telephone | 704-381-3510
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Fax | 704-540-3668
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Provider Business Mailing Address
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Address Line | PO BOX 602148
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City | CHARLOTTE
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State | NC
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Zip | 28260-2148
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Country | US
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Telephone | 704-381-3510
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Fax | 704-540-3668
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 9600282
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 18483
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 2088P0231X
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Taxonomy Name | Pediatric Urology Physician
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License Number | 9600282
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License Number State | NC
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