Provider Demographics
NPI:1457396053
Name:UTECHT, LAURE AN (MD)
Entity Type:Individual
Prefix:
First Name:LAURE
Middle Name:AN
Last Name:UTECHT
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE A200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-5130
Practice Address - Fax:864-454-5126
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC209912080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC209919Medicaid
SC7928169OtherAETNA ID
SC576007863095OtherBCBS OF SC ID
SC576007863096OtherBLUE CHOICE OF SC
SC370017228OtherRR MEDICARE
SCH206197951Medicare PIN
SC370017228OtherRR MEDICARE
SCH206196904Medicare PIN