MEDICARE: DR. PAUL ANTHONY LEPAGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	17137	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F823815019	OTHER	SC	MEDICARE PIN
2	P00453884	OTHER	SC	RR MEDICARE
4	F823813365	OTHER	SC	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255334306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ANTHONY LEPAGE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 743070
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-3070
Country	:	US
Telephone Number	:	864-560-4304
Fax Number	:	864-560-4413

Provider Business Practice Location Address
First Line	:	2755 S HIGHWAY 14 STE 2200
Second Line	:
City	:	GREER
State	:	SC
Zip	:	29650-4936
Country	:	US
Telephone Number	:	864-849-9555
Fax Number	:	864-849-9556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/04/2021

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Directions to “ DR. PAUL ANTHONY LEPAGE M.D.” Practice Location

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