Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 40627 | SC |
NPI | 1003163593 |
---|---|
Provider Name | Ms. Maryam Gondal |
First Address | Conway, SC 29526 |
Second Address | Conway, SC 29526-8747 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 17/03/2018 |