Provider Demographics
NPI:1831289123
Name:GONDI, GOKUL (MD)
Entity Type:Individual
Prefix:
First Name:GOKUL
Middle Name:
Last Name:GONDI
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 1:1655 BERNARDIN AVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2039
Mailing Address - Country:US
Mailing Address - Phone:803-865-4780
Mailing Address - Fax:803-865-4932
Practice Address - Street 1:1655 BERNARDIN AVE
Practice Address - Street 2:SUITE 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2039
Practice Address - Country:US
Practice Address - Phone:803-865-4780
Practice Address - Fax:803-865-4932
Is Sole Proprietor?:No
Enumeration Date:2006-10-15
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23834207LC0200X, 207LP2900X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC182689OtherAETNA
SC182689OtherMEDCOST
SC238344Medicaid
SC238344OtherSELECT HEALTH
SC238344Medicaid
SCH863197682Medicare PIN
SC182689OtherAETNA