Provider Demographics
NPI:1689672974
Name:CONNELLY, KAREN L (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:L
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2214 OLD CHEROKEE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-9725
Mailing Address - Country:US
Mailing Address - Phone:803-928-5525
Mailing Address - Fax:803-928-5505
Practice Address - Street 1:1995 SAINT MATTHEWS RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2405
Practice Address - Country:US
Practice Address - Phone:803-928-5525
Practice Address - Fax:803-928-5505
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-05-20
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Provider Licenses
StateLicense IDTaxonomies
SC14956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP0966Medicaid