Provider Demographics
NPI:1861540577
Name:LEVY, ANTOINETTE DONNA-MARIE
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:DONNA-MARIE
Last Name:LEVY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 S SHARON AMITY RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-2978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:309 S SHARON AMITY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2978
Practice Address - Country:US
Practice Address - Phone:704-446-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00764363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8102047Medicaid
NC1861540577Medicaid
NY01485354Medicaid
NC2769396IMedicare PIN
NC1861540577Medicaid
NC2769396HMedicare PIN
NC2769396MMedicare PIN
NC2769396PMedicare PIN
NY01485354Medicaid
NC2769396CMedicare PIN
NC2769396FMedicare PIN
NC2769396KMedicare PIN
NC2769396DMedicare PIN
NC2769396AMedicare PIN
NC2769396GMedicare PIN
NC2769396Medicare PIN
NCNC6078BMedicare UPIN
NC2769396LMedicare PIN
NCNC6078BMedicare PIN
NCNC6078AMedicare PIN
NCNC6078AMedicare UPIN
NC2769396EMedicare PIN
NC2769396JMedicare PIN