Healthcare Provider Details

I. General information

NPI: 1053362178
Provider Name (Legal Business Name): SANJEEV KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N FANT ST
ANDERSON SC
29621-5717
US

IV. Provider business mailing address

819 N FANT ST
ANDERSON SC
29621-5717
US

V. Phone/Fax

Practice location:
  • Phone: 864-261-1800
  • Fax: 864-261-1856
Mailing address:
  • Phone: 864-261-1800
  • Fax: 864-261-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number28036
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number28036
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: