Healthcare Provider Details

I. General information

NPI: 1538366737
Provider Name (Legal Business Name): ANISHA KUMAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANISHA BAJAJ M.D.

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N A ST
EASLEY SC
29640-2144
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-855-0001
  • Fax: 864-855-5030
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34008
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier340081
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: