Provider Demographics
NPI:1609654714
Name:MEDLIFE INTERNAL MEDICINE AND PRIMARY CARE, LLC
Entity Type:Organization
Organization Name:MEDLIFE INTERNAL MEDICINE AND PRIMARY CARE, LLC
Other - Org Name:MEDLIFE IM-PCP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIPIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-798-4080
Mailing Address - Street 1:1403 E GREENVILLE ST STE D
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-2285
Mailing Address - Country:US
Mailing Address - Phone:443-798-4080
Mailing Address - Fax:
Practice Address - Street 1:1403 E GREENVILLE ST STE D
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-2285
Practice Address - Country:US
Practice Address - Phone:443-798-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty