Healthcare Provider Details

I. General information

NPI: 1508158544
Provider Name (Legal Business Name): NAGAVIVEK PAAVAN VASUKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N CASHUA DR
FLORENCE SC
29501-2098
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-8575
US

V. Phone/Fax

Practice location:
  • Phone: 843-664-9393
  • Fax: 843-664-9661
Mailing address:
  • Phone: 864-359-1308
  • Fax: 239-496-3939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberTL38008
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number173270
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: