Individual
SUDHA GARIMELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
200 PATEWOOD DR, SUITE A115, GREENVILLE, SC 29615-3593
(864) 454-5105
(864) 241-9200
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6306
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
002489
NY
2080P0210X
Pediatric Nephrology Physician
002489
NY
2080P0210X
Pediatric Nephrology Physician
Primary
40282
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00027438501
UNIVERA
—
01
—
000528365001
BC/BS
—
01
—
000528365002
BC/BS
—
05
—
02722645
—
NY
01
—
060321000050
FIDELIS
—
01
—
1213131
IHA
—
Enumeration date
04/15/2006
Last updated
12/22/2016
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