# VALEANT MEDICAL GROUP PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1942917380
- **Authorized official:** DR. PHANI MOHAN VUPADHYAYULA MD (MEMBER)
- **Authorized official phone:** (704) 813-7476

## Contact information

- **Practice address:** 1795 DR FRANK GASTON BLVD, ROCK HILL, SC 29732-1190
- **Practice address phone:** (803) 326-3500
- **Practice address fax:** (893) 336-3632
- **Mailing address:** 1121 BALTUSROL LN, WAXHAW, NC 28173-9031
- **Mailing address phone:** (704) 813-7476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 11/04/2022
- **Last updated:** 08/29/2024