Healthcare Provider Details

I. General information

NPI: 1215324116
Provider Name (Legal Business Name): SANDEEP KUMAR PURI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SANDEEP KUMAR

II. Dates (important events)

Enumeration Date: 04/20/2015
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 RICHLAND MEDICAL PARK DR STE 310
COLUMBIA SC
29203-6883
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8450
  • Fax: 803-434-0137
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number91546
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60486
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number275177
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number91546
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: