Provider Demographics
NPI:1629164876
Name:NADIMPALLI, ADITYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ADITYA
Middle Name:
Last Name:NADIMPALLI
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:PO BOX 648
Mailing Address - Street 2:USC DEPT. OF INTERNAL MEDICINE
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-0648
Mailing Address - Country:US
Mailing Address - Phone:803-540-1000
Mailing Address - Fax:803-540-1075
Practice Address - Street 1:2 MEDICAL PARK ROAD SUITE 501
Practice Address - Street 2:USC-DEPT. OF INTERNAL MEDICINE
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6876
Practice Address - Country:US
Practice Address - Phone:803-540-1000
Practice Address - Fax:803-540-1075
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA025803207RE0101X, 207R00000X
SC38965207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC389653Medicaid
SCSC72962603Medicare PIN