Provider Demographics
NPI:1487744777
Name:GONDI, GANDHI (MD)
Entity type:Individual
Prefix:DR
First Name:GANDHI
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:PO BOX 601964
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1964
Mailing Address - Country:US
Mailing Address - Phone:855-477-2477
Mailing Address - Fax:216-472-2740
Practice Address - Street 1:2435 FOREST DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2026
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:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8218207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC77835OtherMEDCOST
SC050028864OtherRR MEDICARE
SC4129444OtherAETNA
SC082181Medicaid
SC2000116OtherCCP
SC082181OtherSELECT HEALTH
SC082181Medicaid
SC2000116OtherCCP
SCE02385Medicare UPIN