Provider Demographics
NPI:1528334372
Name:PATIDAR, AVNIK KIRIT (MD)
Entity type:Individual
Prefix:
First Name:AVNIK
Middle Name:KIRIT
Last Name:PATIDAR
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:803-791-2000
Mailing Address - Fax:
Practice Address - Street 1:145 SUNSET CT STE 100&201
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-2466
Practice Address - Country:US
Practice Address - Phone:803-739-3550
Practice Address - Fax:803-739-3546
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-27
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38699208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC386996Medicaid