Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 002489 | NY |
N | 2080P0210X | Pediatric Nephrologist | 002489 | NY |
Y | 2080P0210X | Pediatric Nephrologist | 40282 | SC |
NPI | 1558325407 |
---|---|
Provider Name | Sudha Garimella |
First Address | Greenville, SC 29615-4545 |
Second Address | Greenville, SC 29615-3593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2006 |
Last Update Date | 22/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00027438501 | UNIVERA (01) | |
000528365001 | BC/BS (01) | |
000528365002 | BC/BS (01) | |
02722645 | (05) | NY |
060321000050 | FIDELIS (01) | |
1213131 | IHA (01) | |
I46729 | (02) |