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General NPI Number Information
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NPI Number | 1093732091
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Entity Type | Individual
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Provider Name | LAURIE LYNN MALMSTROM MD
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Gender | Female
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 701 GROVE RD GMH ER ADMINISTRATION
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City | GREENVILLE
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State | SC
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Zip | 29605-5611
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Country | US
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Telephone | 864-455-6372
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Fax |
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Provider Business Mailing Address
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Address Line | 255 ENTERPRISE BLVD SUITE 250
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City | GREENVILLE
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State | SC
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Zip | 29615-6300
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Country | US
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Telephone | 864-454-0888
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Fax | 864-454-1130
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207PP0204X
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Taxonomy Name | Pediatric Emergency Medicine (Emergency Medicine) Physician
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License Number | 21139
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License Number State | SC
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