Basic Information
| Provider Information | |||||||||
| NPI: | 1639572266 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOPRESTO | ||||||||
| FirstName: | STEVEN | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3980 HIGHWAY 9 E STE 200 | ||||||||
| Address2: | |||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295668164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433900100 | ||||||||
| FaxNumber: | 8433900038 | ||||||||
| Practice Location | |||||||||
| Address1: | 3980 HIGHWAY 9 E STE 200 | ||||||||
| Address2: | |||||||||
| City: | LITTLE RIVER | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295668164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8433900100 | ||||||||
| FaxNumber: | 8433900038 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2014 | ||||||||
| LastUpdateDate: | 03/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | TL2204 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 2061PA | 05 | SC | MEDICAID |