Healthcare Provider Details

I. General information

NPI: 1275543928
Provider Name (Legal Business Name): VIDYA AJARADDER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PELHAM ROAD
GREENVILLE SC
29615-3300
US

IV. Provider business mailing address

800 PELHAM ROAD
GREENVILLE SC
29615-3300
US

V. Phone/Fax

Practice location:
  • Phone: 864-234-5800
  • Fax: 864-234-5881
Mailing address:
  • Phone: 864-234-5800
  • Fax: 864-234-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number32430
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: