Provider Demographics
NPI:1215973532
Name:PATEL, PRAVIN R (MD)
Entity type:Individual
Prefix:DR
First Name:PRAVIN
Middle Name:R
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 417
Mailing Address - Street 2:
Mailing Address - City:CLIO
Mailing Address - State:SC
Mailing Address - Zip Code:29525
Mailing Address - Country:US
Mailing Address - Phone:843-586-2292
Mailing Address - Fax:843-586-2664
Practice Address - Street 1:200 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIO
Practice Address - State:SC
Practice Address - Zip Code:29525
Practice Address - Country:US
Practice Address - Phone:843-586-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11313207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8906247Medicaid
SCRHC120Medicaid
NC428949CMedicaid
NC428949AMedicaid
SC11313-9Medicaid
D750770282Medicare ID - Type Unspecified
NC428949AMedicaid
SC11313-9Medicaid