Healthcare Provider Details

I. General information

NPI: 1376834606
Provider Name (Legal Business Name): HEART ASSOCIATE OF HILTON HEAD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 WESTBURY PARK SUITE 103
BLUFFTON SC
29910-7461
US

IV. Provider business mailing address

14 WESTBURY PARK SUITE 103
BLUFFTON SC
29910-7461
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-4673
  • Fax: 877-599-0017
Mailing address:
  • Phone: 843-682-4673
  • Fax: 877-599-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAVINA BALCHANDANI
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 631-255-3617