Provider Demographics
NPI:1356652283
Name:ABIRAJ, VISHAL (MBBS)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:ABIRAJ
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 MCGEE ST
Mailing Address - Street 2:
Mailing Address - City:BAMBERG
Mailing Address - State:SC
Mailing Address - Zip Code:29003-1154
Mailing Address - Country:US
Mailing Address - Phone:803-956-6100
Mailing Address - Fax:803-632-1209
Practice Address - Street 1:185 MCGEE ST
Practice Address - Street 2:
Practice Address - City:BAMBERG
Practice Address - State:SC
Practice Address - Zip Code:29003-1154
Practice Address - Country:US
Practice Address - Phone:803-956-6100
Practice Address - Fax:803-632-1209
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36549207RI0200X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC365492Medicaid
SC36549OtherMEDICAL LICENSE
SCSC3469OtherMEDICARE