Provider Demographics
NPI:1508424383
Name:LURIE, ALYSSA MICHELLE
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:MICHELLE
Last Name:LURIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-3502
Mailing Address - Country:US
Mailing Address - Phone:843-937-6300
Mailing Address - Fax:
Practice Address - Street 1:75 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-3502
Practice Address - Country:US
Practice Address - Phone:843-937-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22523174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty