Provider Demographics
NPI:1356459218
Name:LOPEZ, STEVEN G (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:G
Last Name:LOPEZ
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 1:2777 SPEISSEGGER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8229
Mailing Address - Country:US
Mailing Address - Phone:843-747-5830
Mailing Address - Fax:843-745-5115
Practice Address - Street 1:4500 LEEDS AVE
Practice Address - Street 2:STE. 219
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8520
Practice Address - Country:US
Practice Address - Phone:843-745-5178
Practice Address - Fax:843-745-5115
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC202472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC202471Medicaid
SCP01078713OtherMEDICARE RAILROAD
H03985Medicare UPIN