MEDICARE: DR. ROBERT SCOTT LAKE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	22236	SC
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	22236	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00727226	OTHER	SC	RAILROAD MEDICARE ID-RSFPP
3	P00269321	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487696019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT SCOTT LAKE MD

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	888-472-0043
Fax Number	:	843-724-2330

Provider Business Practice Location Address
First Line	:	2097 HENRY TECKLENBURG DR STE 201W
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5739
Country	:	US
Telephone Number	:	843-402-1211
Fax Number	:	843-606-8088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	06/11/2025

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Directions to “ DR. ROBERT SCOTT LAKE MD” Practice Location

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