Healthcare Provider Details

I. General information

NPI: 1497985303
Provider Name (Legal Business Name): RUSHIRAJ CHAITANYA LAIWALA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2009
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 HARDEN ST
COLUMBIA SC
29203
US

IV. Provider business mailing address

101 PLAYGROUND RD
BLYTHEWOOD SC
29016-7658
US

V. Phone/Fax

Practice location:
  • Phone: 803-737-5300
  • Fax:
Mailing address:
  • Phone: 423-653-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number50045
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number38447
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: