Healthcare Provider Details

I. General information

NPI: 1578742631
Provider Name (Legal Business Name): CARRIE A LAKIN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 LAIDLEY ST SUITE 602
CHARLESTON WV
25301-1619
US

IV. Provider business mailing address

PO BOX 11528
CHARLESTON WV
25339-1528
US

V. Phone/Fax

Practice location:
  • Phone: 304-347-3668
  • Fax:
Mailing address:
  • Phone: 304-347-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number0359
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: