Healthcare Provider Details

I. General information

NPI: 1811944754
Provider Name (Legal Business Name): GULZAR A MERCHANT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 ENTERPRISE BLVD SUITE 100
GREENVILLE SC
29615-6300
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-2270
  • Fax: 864-454-2279
Mailing address:
  • Phone: 864-797-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number18796
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: