Provider Demographics
NPI:1871562025
Name:PATEL, NITIN A (MD)
Entity type:Individual
Prefix:
First Name:NITIN
Middle Name:A
Last Name:PATEL
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 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:115 BLARNEY DR STE 108
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6291
Practice Address - Country:US
Practice Address - Phone:803-462-9200
Practice Address - Fax:803-699-1474
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC24190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC241900Medicaid
SCP00758129OtherMEDICARE RAILROAD PTAN
SCP00779661OtherMEDICARE RAILROAD PTAN
SCP00779661OtherMEDICARE RAILROAD PTAN
SCAA12927579Medicare PIN
SCAA12925730Medicare PIN
SCI51314Medicare UPIN
SCAA12927647Medicare PIN
SCAA12925736Medicare PIN