Healthcare Provider Details

I. General information

NPI: 1851067946
Provider Name (Legal Business Name): GOWRI ANIL PEETHAMBAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PRISMA HEALTH MEDICAL GROUP NEUROLOGY 8 MEDICAL PARK, STE 420
COLUMBIA SC
29203
US

IV. Provider business mailing address

PRISMA HEALTH MEDICAL GROUP NEUROLOGY 8 MEDICAL PARK, STE 420
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-545-6050
  • Fax: 803-545-6051
Mailing address:
  • Phone: 803-545-6050
  • Fax: 803-545-6051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number54417
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberLL86496
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: