Healthcare Provider Details

I. General information

NPI: 1588663264
Provider Name (Legal Business Name): LEVERNE M PROSSER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEVERNE MARVIN PROSSER MD

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK DR SUITE 300
COLUMBIA SC
29203-8005
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-6511
  • Fax: 803-744-4731
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number19572
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: