Provider Demographics
NPI:1770531972
Name:HEPBURN, LLOYD E JR (MD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:E
Last Name:HEPBURN
Suffix:JR
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2075 EAGLE LANDING BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4074
Practice Address - Country:US
Practice Address - Phone:843-797-5747
Practice Address - Fax:843-797-0857
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18279207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC182796Medicaid
SCP00784095OtherRAILROAD MEDICARE ID-EFF 8/17/2009
SCG204690281Medicare ID - Type Unspecified
SCG204699223Medicare PIN
SC182796Medicaid