Provider Demographics
NPI:1578742631
Name:LAKIN, CARRIE A (DPM)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:LAKIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11528
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25339-1528
Mailing Address - Country:US
Mailing Address - Phone:304-347-3668
Mailing Address - Fax:
Practice Address - Street 1:331 LAIDLEY ST
Practice Address - Street 2:SUITE 602
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1619
Practice Address - Country:US
Practice Address - Phone:304-347-3668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0359213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2103010001Medicaid
WVU81311Medicare UPIN
WV4603390001Medicare NSC
WV4029632Medicare PIN