Healthcare Provider Details

I. General information

NPI: 1801013792
Provider Name (Legal Business Name): NIRAV MANHAR PATEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 TAYLOR ST
COLUMBIA SC
29201-2915
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 32-965-1378
  • Fax: 32-965-4998
Mailing address:
  • Phone: 864-522-8603
  • Fax: 803-708-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTL31245
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberTL31245
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberTL31245
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number31245
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: