MEDICARE: DR. RATNAKISHORE PALLAPOTHU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	258336	NY
2	208600000X	Surgery Physician	239419	MA
3	208600000X	Surgery Physician	88575	SC

General Provider Information

NPI Number	:	1629228549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RATNAKISHORE PALLAPOTHU MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	1850 LAUREL ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2627
Country	:	US
Telephone Number	:	803-256-3400
Fax Number	:	803-806-3549

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2008
Last Update Date	:	09/19/2022

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