MEDICARE: KAUSTUBH GIRISH JOSHI M.D.

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	2084F0202X	Forensic Psychiatry Physician	MD27017	SC

General Provider Information

NPI Number	:	1710947460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAUSTUBH GIRISH JOSHI M.D.

Provider Business Mailing Address
First Line	:	3555 HARDEN ST EXT
Second Line	:	15 MEDICAL PARK SUITE 141
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6894
Country	:	US
Telephone Number	:	803-545-5017
Fax Number	:	803-255-3455

Provider Business Practice Location Address
First Line	:	3555 HARDEN STREET EXT STE 301
Second Line	:	UNIVERSITY OF SOUTH CAROLINA SCHOOL OF MEDICINE
City	:	COLUMBIA
State	:	SC
Zip	:	29203-6894
Country	:	US
Telephone Number	:	803-434-4236
Fax Number	:

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

Provider Enumeration Date	:	03/26/2006
Last Update Date	:	03/29/2017

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