Provider Demographics
NPI:1497985303
Name:LAIWALA, RUSHIRAJ CHAITANYA (MD)
Entity Type:Individual
Prefix:
First Name:RUSHIRAJ
Middle Name:CHAITANYA
Last Name:LAIWALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PLAYGROUND RD
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7658
Mailing Address - Country:US
Mailing Address - Phone:423-653-3043
Mailing Address - Fax:
Practice Address - Street 1:2200 HARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-737-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN500452084P0805X, 2084P0805X
SC384472084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN50045OtherLICENSE