Provider Demographics
NPI: | 1669445235 |
---|---|
Name: | JAMES, ASHA PARDASANI (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | ASHA |
Middle Name: | PARDASANI |
Last Name: | JAMES |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | ASHA |
Other - Middle Name: | GOPAL |
Other - Last Name: | PARDASANI |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | MD |
Mailing Address - Street 1: | 3600 FOREST DR STE 400 |
Mailing Address - Street 2: | |
Mailing Address - City: | COLUMBIA |
Mailing Address - State: | SC |
Mailing Address - Zip Code: | 29204-4057 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 803-779-7316 |
Mailing Address - Fax: | 803-343-2538 |
Practice Address - Street 1: | 3600 FOREST DR STE 400 |
Practice Address - Street 2: | |
Practice Address - City: | COLUMBIA |
Practice Address - State: | SC |
Practice Address - Zip Code: | 29204-4057 |
Practice Address - Country: | US |
Practice Address - Phone: | 803-779-7316 |
Practice Address - Fax: | 803-343-2538 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-02-13 |
Last Update Date: | 2023-03-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
SC | 22241 | 207N00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 070017290 | Other | RAILROAD MEDICARE |
SC | BP7103752 | Other | DEA |
SC | BP7103752 | Other | DEA |
SC | T64150 | Medicaid | |
SC | H286467479 | Medicare ID - Type Unspecified |