Provider Demographics
NPI:1386609931
Name:KINNEY, LAURA LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEE
Last Name:KINNEY
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:PO BOX 13955
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29422-3955
Mailing Address - Country:US
Mailing Address - Phone:843-225-8320
Mailing Address - Fax:843-225-3549
Practice Address - Street 1:2270 ASHLEY CROSSING DR STE 165
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5865
Practice Address - Country:US
Practice Address - Phone:843-936-4455
Practice Address - Fax:843-268-2670
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSCLN19466207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC194667Medicaid
SCH59359A634OtherMEDICARE
SCP00799639OtherRAILROAD MEDICARE ID-RSFPN
SC194667Medicaid
SCH593597832Medicare PIN