Provider Demographics
NPI:1578663498
Name:MALVERN, LORI L (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:MALVERN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:317 SAINT FRANCIS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3965
Mailing Address - Country:US
Mailing Address - Phone:864-255-1901
Mailing Address - Fax:844-318-9058
Practice Address - Street 1:317 SAINT FRANCIS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3965
Practice Address - Country:US
Practice Address - Phone:864-255-1901
Practice Address - Fax:844-318-9058
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2015-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC16958207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC169588Medicaid
SC576007863095OtherBCBS OF SC
SCP00817212OtherRR MEDICARE
SC110204017OtherRR MEDICARE
SCG149417951Medicare PIN
SC169588Medicaid
SCG149413640Medicare PIN