Individual
LAURIE LYNN MALMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
701 GROVE RD, GMH ER ADMINISTRATION, GREENVILLE, SC 29605-5611
(864) 455-6372
Mailing address
255 ENTERPRISE BLVD, SUITE 250, GREENVILLE, SC 29615-6300
(864) 454-0888
(864) 454-1130
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
21139
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
167193
UNISON
SC
01
—
20-21139
SCCS
SC
01
—
20004419
SELECT HEALTH
SC
05
—
211390
—
SC
01
—
57-6007863
BCBS
SC
01
—
930081471
MEDICARE RAILROAD
SC
Enumeration date
07/16/2006
Last updated
03/07/2023
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