1962401570 NPI number — DR. ROCHELLE Y LEPOR D.O.

Table of content: DR. ROCHELLE Y LEPOR D.O. (NPI 1962401570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962401570 NPI number — DR. ROCHELLE Y LEPOR D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEPOR
Provider First Name:
ROCHELLE
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPEZ-LINUS LEPOR
Provider Other First Name:
ROCHELLE
Provider Other Middle Name:
Y
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1962401570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 TIMMS RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALHOUN
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30701-7016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-625-0022
Provider Business Mailing Address Fax Number:
706-625-3803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 TIMMS RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALHOUN
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30701-7016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-625-0022
Provider Business Practice Location Address Fax Number:
706-625-3803
Provider Enumeration Date:
07/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  061119 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 153404709A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1962401570 . This is a "NPI" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".