Provider Demographics
NPI:1851463566
Name:JUNEJA, ANIL KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANIL
Middle Name:KUMAR
Last Name:JUNEJA
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 1:182 LAURELHURST AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-3824
Mailing Address - Country:US
Mailing Address - Phone:803-551-0060
Mailing Address - Fax:803-551-0062
Practice Address - Street 1:182 LAURELHURST AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3824
Practice Address - Country:US
Practice Address - Phone:803-551-0060
Practice Address - Fax:803-551-0062
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC154372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC154371Medicaid
SC154371Medicaid
SC814097640OtherEIN/TIN
SC570938085OtherTAX ID NUMBER
SCE906084049Medicare ID - Type UnspecifiedMEDICARE