Provider Demographics
NPI:1093943466
Name:PATEL, BHADRIK I (PA)
Entity Type:Individual
Prefix:
First Name:BHADRIK
Middle Name:I
Last Name:PATEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 SPARKLEBERRY LANE EXT STE A&B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-7078
Mailing Address - Country:US
Mailing Address - Phone:803-851-0605
Mailing Address - Fax:803-769-7886
Practice Address - Street 1:1120 SPARKLEBERRY LANE EXT STE A&B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-7078
Practice Address - Country:US
Practice Address - Phone:803-851-0605
Practice Address - Fax:803-769-7886
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1501363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPG1133Medicaid
SCN110OtherMEDICARE
SCPA1501OtherMEDICAL LICENSE