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General NPI Number Information
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NPI Number | 1235768797
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Entity Type | Individual
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Provider Name | MAVINDER GURAM
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 3600 FOREST DR STE 400
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City | COLUMBIA
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State | SC
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Zip | 29204-4057
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Country | US
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Telephone | 803-779-7316
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Fax |
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Provider Business Mailing Address
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Address Line | 141 COUNTRY PLACE CT
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City | COLUMBIA
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State | SC
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Zip | 29212-0911
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Country | US
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Telephone | 803-528-1934
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD91657
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License Number State | SC
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