Individual
DR. LAUREN RUTH TUCCILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
853 N CHURCH ST STE 510, SPARTANBURG, SC 29303-3077
(864) 560-6193
Mailing address
853 N CHURCH ST STE 510, SPARTANBURG, SC 29303-3077
(864) 560-6193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
61240
SC
207Q00000X
Family Medicine Physician
LL61240
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
612402
—
SC
01
—
SCI8815019
MEDICARE PIN
SC
Enumeration date
07/13/2018
Last updated
01/07/2021
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