Provider Demographics
NPI:1902930167
Name:LEVIN, STEPHEN WARREN (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:WARREN
Last Name:LEVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:319 CHAPANOKE RD STE 101
Mailing Address - Street 2:MAIL SERVICE CENTER # 2074
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27699-2074
Mailing Address - Country:US
Mailing Address - Phone:919-662-4600
Mailing Address - Fax:919-662-4473
Practice Address - Street 1:319 CHAPANOKE RD STE 101
Practice Address - Street 2:MAIL SERVICE CENTER # 2074
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27699-2074
Practice Address - Country:US
Practice Address - Phone:919-662-4600
Practice Address - Fax:919-662-4473
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC23400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC139C3OtherBCBS #
BL7128184OtherDEA
NC139C3OtherBCBS #