Provider Demographics
NPI:1629029913
Name:CARR, LADY M (MD)
Entity Type:Individual
Prefix:
First Name:LADY
Middle Name:M
Last Name:CARR
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:PO BOX 485
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0485
Mailing Address - Country:US
Mailing Address - Phone:803-898-8405
Mailing Address - Fax:803-898-8526
Practice Address - Street 1:610 FAISON DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-3218
Practice Address - Country:US
Practice Address - Phone:803-898-8405
Practice Address - Fax:803-898-8526
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21596207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC215966Medicaid
SCAA52763357Medicare UPIN
SCAA52763350Medicare UPIN
SC215966Medicaid
SCAA52763355Medicare UPIN