Healthcare Provider Details

I. General information

NPI: 1750413241
Provider Name (Legal Business Name): EASTSIDE HEMATOLOGY ONCOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4210 E NORTH ST
GREENVILLE SC
29615-2423
US

IV. Provider business mailing address

PO BOX 26683
GREENVILLE SC
29616-1683
US

V. Phone/Fax

Practice location:
  • Phone: 864-244-6777
  • Fax: 864-244-4212
Mailing address:
  • Phone: 864-244-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: PINJAI RAMADAS RAVICHANDER
Title or Position: SOLE SHAREHOLDER
Credential: M.D.
Phone: 864-244-6777