Individual
LOPA SISODIA BHANSALY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
109 PHYSICIANS DR STE A, GREER, SC 29650-2446
(864) 797-9150
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8617
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1402
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014022
—
SC
01
—
SC15433365
MEDICARE PTAN
SC
Enumeration date
06/18/2010
Last updated
04/30/2021
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