Provider Demographics
NPI:1316075203
Name:LAKE, PIAVE PITISCI (MD)
Entity type:Individual
Prefix:DR
First Name:PIAVE
Middle Name:PITISCI
Last Name:LAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FAIRCHILD ST STE 170
Mailing Address - Street 2:
Mailing Address - City:DANIEL ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29492-7602
Mailing Address - Country:US
Mailing Address - Phone:803-339-1563
Mailing Address - Fax:803-746-7902
Practice Address - Street 1:115 FAIRCHILD ST STE 170
Practice Address - Street 2:
Practice Address - City:DANIEL ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29492-7602
Practice Address - Country:US
Practice Address - Phone:803-339-1563
Practice Address - Fax:803-746-7902
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC226272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH538650281Medicare ID - Type Unspecified
SCH53865Medicare UPIN