Provider Demographics
NPI:1427141167
Name:VERMA, ANURADHA
Entity type:Individual
Prefix:
First Name:ANURADHA
Middle Name:
Last Name:VERMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GOLD HILL RD
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-8906
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:704 GOLD HILL RD
Practice Address - Street 2:SUITE 1200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-8906
Practice Address - Country:US
Practice Address - Phone:704-667-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30498207Q00000X, 207Q00000X
NC2008-00530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1427141167Medicaid
SC304986Medicaid
NC5913341Medicaid
NC2073906LMedicare PIN
NC2073906JMedicare PIN
NCNCA131BMedicare PIN
NCNCA131CMedicare PIN
NC5913341Medicaid
NC2073906KMedicare PIN
NC2073906MMedicare PIN
NCNCA131DMedicare PIN
NC2073906AMedicare PIN
NC2073906HMedicare PIN
SCAA59537772Medicare PIN
NC2073906DMedicare PIN
NCNCA131AMedicare PIN
NC1427141167Medicaid
NC2073906EMedicare PIN
NC2073906CMedicare PIN
NC2073906FMedicare PIN
NC2073906NMedicare PIN
NC2073906BMedicare PIN