MEDICARE: BHADRIK I PATEL PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1501	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	N110	OTHER	SC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	PA1501	OTHER	SC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1093943466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BHADRIK I PATEL PA

Provider Business Mailing Address
First Line	:	1120 SPARKLEBERRY LANE EXT STE A&B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7078
Country	:	US
Telephone Number	:	803-851-0605
Fax Number	:	803-769-7886

Provider Business Practice Location Address
First Line	:	1120 SPARKLEBERRY LANE EXT STE A&B
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7078
Country	:	US
Telephone Number	:	803-851-0605
Fax Number	:	803-769-7886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	02/01/2024

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Directions to “ BHADRIK I PATEL PA” Practice Location

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