MEDICARE: ENT CAROLINA PA

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	174400000X	Specialist

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

General Provider Information

NPI Number	:	1346471976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENT CAROLINA PA

Provider Business Mailing Address
First Line	:	2520 ABERDEEN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-0635
Country	:	US
Telephone Number	:	704-868-8400
Fax Number	:	704-868-8493

Provider Business Practice Location Address
First Line	:	1180 WYKE RD
Second Line	:
City	:	SHELBY
State	:	NC
Zip	:	28150-4259
Country	:	US
Telephone Number	:	704-487-9100
Fax Number	:	704-487-5230

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. FREDERIC E LEVY
Credential	:	MD
Telephone Number	:	704-868-8400

Provider Enumeration Date	:	07/30/2009
Last Update Date	:	07/30/2009

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Directions to “ENT CAROLINA PA ” Practice Location

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