Healthcare Provider Details

I. General information

NPI: 1679148340
Provider Name (Legal Business Name): PINAL GOVINDBHAI PATEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date: 03/29/2023
Reactivation Date: 06/12/2023

III. Provider practice location address

847 FARRAR DR
CONWAY SC
29526-8747
US

IV. Provider business mailing address

847 FARRAR DR
CONWAY SC
29526-8747
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-9487
  • Fax:
Mailing address:
  • Phone: 843-347-1263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number96501
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: