Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 23724 | SC |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 23724 | SC |
NPI | 1043277304 |
---|---|
Provider Name | Prabal K. Guha |
First Address | Florence, SC 29502-3239 |
Second Address | Florence, SC 29506-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2006 |
Last Update Date | 22/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
237247 | (05) | SC |
H76775 | (02) |