Provider Demographics
NPI:1700836301
Name:PREYER, LUCY WOLTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:WOLTZ
Last Name:PREYER
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 1:1030 JENKINS RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5500
Mailing Address - Country:US
Mailing Address - Phone:843-766-8820
Mailing Address - Fax:
Practice Address - Street 1:1030 JENKINS RD
Practice Address - Street 2:SUITE A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5500
Practice Address - Country:US
Practice Address - Phone:843-766-8820
Practice Address - Fax:843-766-8817
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC202562084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP371OtherMEDICAID GROUP
SC202569Medicaid
SC7775OtherMEDICARE GROUP
SCAA98980281Medicare PIN
SCF23484Medicare UPIN
SC202569Medicaid