Provider Demographics
NPI:1952711483
Name:LAPENNA, PAUL (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:LAPENNA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743294
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3294
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BON SECOURS NEUROLOGY
Practice Address - Street 2:801 ROPER CREEK DRIVE
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6938
Practice Address - Country:US
Practice Address - Phone:864-516-1170
Practice Address - Fax:877-249-9483
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC519122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC519120Medicaid