Provider Demographics
NPI:1972619658
Name:LEPGOLD, EDITH (MD)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:LEPGOLD
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 1:1301 W 38TH ST STE 601
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1015
Mailing Address - Country:US
Mailing Address - Phone:512-454-5171
Mailing Address - Fax:
Practice Address - Street 1:1301 W 38TH ST STE 601
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1015
Practice Address - Country:US
Practice Address - Phone:512-454-5171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5814207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186992703Medicaid
TX8J8409Medicare PIN
TXB54542Medicare UPIN
TX186992703Medicaid
TX8L1077Medicare PIN
TX8J8410Medicare PIN