Provider Demographics
NPI:1821098823
Name:DEVORE, KAREN A (MD)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:A
Last Name:DEVORE
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 1:490 FLOYD RD
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1518
Mailing Address - Country:US
Mailing Address - Phone:864-596-7546
Mailing Address - Fax:864-596-7549
Practice Address - Street 1:490 FLOYD RD
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1518
Practice Address - Country:US
Practice Address - Phone:864-596-7546
Practice Address - Fax:864-596-7549
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15854207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC158544Medicaid
SC158544Medicaid
SCF007227185Medicare PIN