Provider Demographics
NPI:1255334306
Name:LEPAGE, PAUL ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ANTHONY
Last Name:LEPAGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:ANTHONY
Other - Last Name:LEPAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:2755 S HIGHWAY 14 STE 2200
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-4936
Practice Address - Country:US
Practice Address - Phone:864-849-9555
Practice Address - Fax:864-849-9556
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17137208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF823815019OtherMEDICARE PIN
SCP00453884OtherRR MEDICARE
SC171370Medicaid
SCF823813365OtherMEDICARE PIN
NC8905622Medicaid
SCP00453884OtherRR MEDICARE
SCF82381Medicare UPIN
SC171370Medicaid