Healthcare Provider Details

I. General information

NPI: 1508873266
Provider Name (Legal Business Name): DIPIKA P PATEL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 10/08/2021
Certification Date: 10/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 PERPETUAL SQ
ANDERSON SC
29621-1713
US

IV. Provider business mailing address

130 PERPETUAL SQ
ANDERSON SC
29621-1713
US

V. Phone/Fax

Practice location:
  • Phone: 864-224-8689
  • Fax: 864-222-1303
Mailing address:
  • Phone: 864-224-8689
  • Fax: 864-222-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number538
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: