Provider Demographics
NPI:1316933559
Name:STROUD, LAWRENCE E JR (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:E
Last Name:STROUD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 OLD GREENVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:SC
Mailing Address - Zip Code:29670-9206
Mailing Address - Country:US
Mailing Address - Phone:864-646-9517
Mailing Address - Fax:
Practice Address - Street 1:2229 OLD GREENVILLE HWY
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670
Practice Address - Country:US
Practice Address - Phone:864-855-1036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9099207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-0739752OtherCORP. FEDERAL ID NUMBER
SC110048374OtherRAILROAD MEDICARE PROV NO
SC42D0252876OtherCLIA NUMBER
SC090993Medicaid
SCPA4726OtherGROUP MEDICAID NUMBER
SCC61012Medicare UPIN