MEDICARE: PALMETTO NEPHROLOGY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962433565
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO NEPHROLOGY PA

Provider Business Mailing Address
First Line	:	3031 SAINT MATTHEWS RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-1443
Country	:	US
Telephone Number	:	803-531-2677
Fax Number	:	803-531-6137

Provider Business Practice Location Address
First Line	:	3031 SAINT MATTHEWS RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-1443
Country	:	US
Telephone Number	:	803-531-2677
Fax Number	:	803-531-6137

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MOHAMMAD S NASSRI
Credential	:	MD
Telephone Number	:	803-531-2677

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	08/05/2021

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