Provider Demographics
NPI:1831185438
Name:LEPORE, HENRY (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:LEPORE
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 1:830 SUNSET BLVD N
Mailing Address - Street 2:
Mailing Address - City:SUNSET BEACH
Mailing Address - State:NC
Mailing Address - Zip Code:28468-4262
Mailing Address - Country:US
Mailing Address - Phone:910-575-5750
Mailing Address - Fax:910-575-5751
Practice Address - Street 1:830 SUNSET BLVD N
Practice Address - Street 2:
Practice Address - City:SUNSET BEACH
Practice Address - State:NC
Practice Address - Zip Code:28468-4262
Practice Address - Country:US
Practice Address - Phone:910-575-5750
Practice Address - Fax:910-575-5751
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01376208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8911413Medicaid
NC012EKOtherBLUE CROSS BLUE SHIELD NC
NCG39800Medicare UPIN
NC2233110AMedicare ID - Type Unspecified