MEDICARE: DR. SURBJINDER S GURAM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	11931	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110188005	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	562124971	OTHER	SC	CHAMPUS/TRICARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	562124971	OTHER	SC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1346208568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SURBJINDER S GURAM MD

Provider Business Mailing Address
First Line	:	7182 WOODROW ST STE 200
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2832
Country	:	US
Telephone Number	:	803-749-1111
Fax Number	:	803-749-0050

Provider Business Practice Location Address
First Line	:	1 WELLNESS BLVD STE 109
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2872
Country	:	US
Telephone Number	:	803-749-1111
Fax Number	:	803-749-0050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/05/2024

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Directions to “ DR. SURBJINDER S GURAM MD” Practice Location

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