Provider Demographics
NPI:1508864927
Name:LEPINE, EUGENE M (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:M
Last Name:LEPINE
Suffix:
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 1:1533 EBENEZER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1806
Mailing Address - Country:US
Mailing Address - Phone:803-328-1831
Mailing Address - Fax:803-324-5131
Practice Address - Street 1:1533 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1806
Practice Address - Country:US
Practice Address - Phone:803-328-1831
Practice Address - Fax:803-328-0283
Is Sole Proprietor?:No
Enumeration Date:2005-07-10
Last Update Date:2022-11-14
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2007-10-17
Provider Licenses
StateLicense IDTaxonomies
SC06954174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC069543Medicaid