Provider Demographics
NPI:1659561421
Name:CASTLEBERRY, LAUREN A (MD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:A
Last Name:CASTLEBERRY
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:811 W MAIN ST STE 201&209
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2507
Practice Address - Country:US
Practice Address - Phone:803-785-4774
Practice Address - Fax:803-358-6240
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC37302207V00000X
IL125053153207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC373027Medicaid
SCSC39833922Medicare PIN