Provider Demographics
NPI:1720304314
Name:LORENC, CAROLYN D (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:D
Last Name:LORENC
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 1:7718 LAKE VISTA CT UNIT 307
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2123
Mailing Address - Country:US
Mailing Address - Phone:941-907-0423
Mailing Address - Fax:
Practice Address - Street 1:1900 BROTHER GEENEN WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-7102
Practice Address - Country:US
Practice Address - Phone:941-556-3215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00482262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE21811Medicare UPIN