Provider Demographics
NPI:1093732091
Name:MALMSTROM, LAURIE LYNN (MD)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LYNN
Last Name:MALMSTROM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:255 ENTERPRISE BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-6300
Mailing Address - Country:US
Mailing Address - Phone:864-454-0888
Mailing Address - Fax:864-454-1130
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:GMH ER ADMINISTRATION
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-5611
Practice Address - Country:US
Practice Address - Phone:864-455-6372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC21139207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC211390Medicaid
SC57-6007863OtherBCBS
SC57-6007863OtherBLUE CHOICE
SC57-6007863OtherTRICARE
SC167193OtherUNISON
SC930081471OtherMEDICARE RAILROAD
SC20-21139OtherSCCS
SC20004419OtherSELECT HEALTH
SC20004419OtherSELECT HEALTH
SC211390Medicaid