Provider Demographics
NPI:1255578860
Name:KORN, LARY RICHARD (DO)
Entity type:Individual
Prefix:DR
First Name:LARY
Middle Name:RICHARD
Last Name:KORN
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 HINDMAN DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-4621
Mailing Address - Country:US
Mailing Address - Phone:864-266-2413
Mailing Address - Fax:
Practice Address - Street 1:37 HINDMAN DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-4621
Practice Address - Country:US
Practice Address - Phone:864-266-2413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA44513208D00000X
SC0311208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA36138016Medicare UPIN
SC6238630001Medicare NSC