Provider Demographics
NPI:1851067946
Name:PEETHAMBAR, GOWRI ANIL (MD)
Entity Type:Individual
Prefix:
First Name:GOWRI
Middle Name:ANIL
Last Name:PEETHAMBAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PRISMA HEALTH MEDICAL GROUP NEUROLOGY
Mailing Address - Street 2:8 MEDICAL PARK, STE 420
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-545-6050
Mailing Address - Fax:803-545-6051
Practice Address - Street 1:PRISMA HEALTH MEDICAL GROUP NEUROLOGY
Practice Address - Street 2:8 MEDICAL PARK, STE 420
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-545-6050
Practice Address - Fax:803-545-6051
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCLL864962084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology