Provider Demographics
NPI:1386641405
Name:SOKHANDAN, MEHRGAN (MD)
Entity type:Individual
Prefix:DR
First Name:MEHRGAN
Middle Name:
Last Name:SOKHANDAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3415
Mailing Address - Country:US
Mailing Address - Phone:864-627-5337
Mailing Address - Fax:864-627-9301
Practice Address - Street 1:357 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3415
Practice Address - Country:US
Practice Address - Phone:864-627-5337
Practice Address - Fax:864-627-9301
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17953207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC582299730OtherTAX ID
SCT20518Medicaid
SCF72656995Medicare ID - Type UnspecifiedMEDICARE- GREENVILLE
SCF72654Medicare UPIN
SC6996Medicare PIN