Provider Demographics
NPI:1588663264
Name:PROSSER, LEVERNE M (MD)
Entity type:Individual
Prefix:DR
First Name:LEVERNE
Middle Name:M
Last Name:PROSSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:LEVERNE
Other - Middle Name:MARVIN
Other - Last Name:PROSSER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8005
Practice Address - Country:US
Practice Address - Phone:803-256-6511
Practice Address - Fax:803-744-4731
Is Sole Proprietor?:No
Enumeration Date:2005-07-15
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19572207RC0000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC195728Medicaid
SC19572OtherSC LICENSE
SCH08898Medicare UPIN