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General NPI Number Information
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NPI Number | 1215324116
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Entity Type | Individual
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Provider Name | SANDEEP KUMAR PURI MD
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Gender | Male
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Dates
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Enumeration Date | 04/20/2015
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Last Update Date | 06/28/2024
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Provider Practice Location Address
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Address Line | 14 RICHLAND MEDICAL PARK DR STE 310
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City | COLUMBIA
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State | SC
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Zip | 29203-6883
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Country | US
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Telephone | 803-434-8450
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Fax | 803-434-0137
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Provider Business Mailing Address
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Address Line | 300 E MCBEE AVE FL 4
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City | GREENVILLE
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State | SC
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Zip | 29601-2842
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Country | US
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Telephone | 864-522-8603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 91546
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 60486
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 275177
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 91546
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License Number State | SC
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