Healthcare Provider Details

I. General information

NPI: 1649447509
Provider Name (Legal Business Name): VIKRAM REDDY VATTIPALLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 10/19/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 CORPORATE GATEWAY BLVD STE 420
COLUMBIA SC
29420
US

IV. Provider business mailing address

PO BOX 23469
NEW YORK NY
10087-3469
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number273895
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number88247
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: