=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811944754
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GULZAR A MERCHANT M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2006
-----------------------------------------------------
Last Update Date | 12/31/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 ENTERPRISE BLVD SUITE 100
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615-6300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-454-2270
-----------------------------------------------------
Fax | 864-454-2279
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 INDEPENDENCE PT SUITE 212
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29615-4545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-797-6044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 18796
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------