Provider Demographics
NPI:1508870874
Name:POKHARNA, RENU (MD)
Entity Type:Individual
Prefix:
First Name:RENU
Middle Name:
Last Name:POKHARNA
Suffix:
Gender:F
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:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:8 RICHLAND MEDICAL PARK
Practice Address - Street 2:SUITE 420
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8004
Practice Address - Country:US
Practice Address - Phone:803-545-6050
Practice Address - Fax:803-545-6051
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390342084N0400X
PAMD4294032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017067070003Medicaid
SC390348Medicaid
PA102638Medicare PIN
I56747Medicare UPIN
PA1017067070003Medicaid
SCSC7462F935Medicare PIN