Provider Demographics
NPI:1518018340
Name:MICHAEL A. LEPORE, JR., M.D.
Entity Type:Organization
Organization Name:MICHAEL A. LEPORE, JR., M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEPORE, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-686-8700
Mailing Address - Street 1:1510 BREEZEPORT WAY STE 600
Mailing Address - Street 2:HARBOUR BREEZE PROFESSIONAL CENTER
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3738
Mailing Address - Country:US
Mailing Address - Phone:757-686-8700
Mailing Address - Fax:757-686-8006
Practice Address - Street 1:1510 BREEZEPORT WAY STE 600
Practice Address - Street 2:HARBOUR BREEZE PROFESSIONAL CENTER
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3738
Practice Address - Country:US
Practice Address - Phone:757-686-8700
Practice Address - Fax:757-686-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901723Medicaid
VA160058189OtherRAILROAD MEDICARE
VA006209181Medicaid
VA49D0863102OtherCLIA NUMBER
VA49D0863102OtherCLIA NUMBER
VA160001373Medicare ID - Type Unspecified