Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 632-L | MS |
N | 111NI0900X | Internist | 632-L | MS |
Y | 207RH0003X | Hematology & Oncology | 40329 | SC |
NPI | 1013128792 |
---|---|
Provider Name | Dr. Vikas Dembla |
First Address | Atlanta, GA 30374-3070 |
Second Address | Spartanburg, SC 29303-3040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 18/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
403290 | (05) | SC |
SC96873365 | MEDICARE PIN (01) | SC |