Individual
MANDEV GURAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7182 WOODROW ST STE 200, IRMO, SC 29063-2832
(803) 749-1111
(803) 749-0050
Mailing address
7182 WOODROW ST STE 200, IRMO, SC 29063-2832
(803) 749-1111
(803) 749-0050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
38279
SD
207R00000X
Internal Medicine Physician
Primary
LL38279
SC
207R00000X
Internal Medicine Physician
MD38279
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
382794
—
SD
Enumeration date
06/12/2015
Last updated
02/26/2024
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