Provider Demographics
NPI:1992090765
Name:LOPER, PETER LOUIS JR (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:LOUIS
Last Name:LOPER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 ISLAND VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-9180
Mailing Address - Country:US
Mailing Address - Phone:704-953-2988
Mailing Address - Fax:
Practice Address - Street 1:910 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2124
Practice Address - Country:US
Practice Address - Phone:803-534-2328
Practice Address - Fax:803-531-8419
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL33543208000000X
SC335432084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC335435Medicaid