Individual
LANNEAU D LIDE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 254-3278
(803) 929-3256
Mailing address
2001 LAUREL ST, COLUMBIA, SC 29204-1018
(803) 255-2655
(803) 255-2484
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
10233
SC
207RI0011X
Interventional Cardiology Physician
Primary
10233
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102338
—
SC
Enumeration date
06/23/2006
Last updated
02/24/2016
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