Provider Demographics
NPI:1295718880
Name:LEPSCH, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LEPSCH
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 1:2955 IVY ROAD SUITE 205
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22908-1205
Mailing Address - Country:US
Mailing Address - Phone:434-243-4500
Mailing Address - Fax:434-293-8570
Practice Address - Street 1:1955 IVY ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-1205
Practice Address - Country:US
Practice Address - Phone:434-243-4500
Practice Address - Fax:434-293-8570
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237833207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAAETNAOther7445699
VAANTHEMOther181030
VACIGNAOther1861754
VA010171881Medicaid
VASOUTHERN HEALTHOther321011
VA007874C53Medicare ID - Type Unspecified
VAANTHEMOther181030