Provider Demographics
NPI:1497713143
Name:CARNSEW, LORI R (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:R
Last Name:CARNSEW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:SC
Mailing Address - Zip Code:29657-1012
Mailing Address - Country:US
Mailing Address - Phone:864-843-5605
Mailing Address - Fax:864-843-0996
Practice Address - Street 1:300 W FRONT ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:SC
Practice Address - Zip Code:29657-1012
Practice Address - Country:US
Practice Address - Phone:864-843-5605
Practice Address - Fax:864-843-0996
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH029249342OtherNPI-HOSPITALIST-EAGLE HOSPITALIST PHYSICIANS
1124279872OtherNPI PALMETTO HEALTH-LIBERTY FAMILY CARE
SC1801028543OtherNPI-BAPTIST EASLEY HOSPITAL-LIBERTY FAMILY CARE
SC207109Medicaid
SCGP5257Medicaid
SC9373Medicare UPIN
SCH029248065Medicare PIN
SCH029246578Medicare PIN
SCH029249342OtherNPI-HOSPITALIST-EAGLE HOSPITALIST PHYSICIANS
SCH02924Medicare UPIN
SCH029249373Medicare PIN
SCH029245737Medicare PIN