Healthcare Provider Details

I. General information

NPI: 1215807730
Provider Name (Legal Business Name): ANITA RAMANATHAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 RICHLAND MEDICAL PARK DR STE 420
COLUMBIA SC
29203-8004
US

IV. Provider business mailing address

8 RICHLAND MEDICAL PARK DR STE 420
COLUMBIA SC
29203-8004
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8050
  • Fax:
Mailing address:
  • Phone: 803-434-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL96789
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: