Provider Demographics
NPI:1255307898
Name:WALPOLE, HORACE E JR (MD)
Entity Type:Individual
Prefix:
First Name:HORACE
Middle Name:E
Last Name:WALPOLE
Suffix:JR
Gender:M
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:PO BOX 51158
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:SC
Mailing Address - Zip Code:29673-2158
Mailing Address - Country:US
Mailing Address - Phone:864-220-0103
Mailing Address - Fax:864-220-9925
Practice Address - Street 1:100 POWERS BLVD.
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:SC
Practice Address - Zip Code:29673-2158
Practice Address - Country:US
Practice Address - Phone:864-220-0103
Practice Address - Fax:864-220-9925
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC201124Medicaid
SC8558OtherREGENCY HOSPITAL
SC9617Medicare PIN
SC8558OtherREGENCY HOSPITAL