Healthcare Provider Details

I. General information

NPI: 1467958181
Provider Name (Legal Business Name): NITESH GANDHI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9181 MEDCOM ST
NORTH CHARLESTON SC
29406-9168
US

IV. Provider business mailing address

845 HOUSTON NORTHCUTT BLVD # 1061
MOUNT PLEASANT SC
29464-3446
US

V. Phone/Fax

Practice location:
  • Phone: 843-820-7777
  • Fax:
Mailing address:
  • Phone: 318-626-0287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number326957
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number92329
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: