Provider Demographics
NPI:1598884942
Name:VANA, KARLA M (MD)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:M
Last Name:VANA
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 1:8120 ROURK ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4127
Mailing Address - Country:US
Mailing Address - Phone:443-255-4901
Mailing Address - Fax:843-286-1349
Practice Address - Street 1:8120 ROURK ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4127
Practice Address - Country:US
Practice Address - Phone:843-449-1438
Practice Address - Fax:843-286-1349
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021495208000000X
KY39146208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009989525Medicaid
KY64098460Medicaid
SC302933Medicaid