Individual
MS. SUDHARANI BANGALORE NANJAIAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
115 N SUMTER ST STE 400, SUMTER, SC 29150
(803) 774-7425
(803) 774-9426
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(038) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
81670
SC
207Q00000X
Family Medicine Physician
MD434991
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025377070001
—
PA
05
—
816709
—
SC
Enumeration date
05/14/2008
Last updated
03/18/2019
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