Provider Demographics
NPI:1326030529
Name:LEVREAU, MARJORIE S (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:S
Last Name:LEVREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 CAROLINA BLVD
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-7052
Mailing Address - Country:US
Mailing Address - Phone:828-627-2211
Mailing Address - Fax:828-627-2216
Practice Address - Street 1:30 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NC
Practice Address - Zip Code:28716-3805
Practice Address - Country:US
Practice Address - Phone:828-646-0080
Practice Address - Fax:828-627-2216
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2015-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89134MUMedicaid
NC89134MUMedicaid
NC2016016Medicare ID - Type Unspecified