Provider Demographics
NPI:1396005773
Name:MAKADIA, MANTHAN DIPAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MANTHAN
Middle Name:DIPAK
Last Name:MAKADIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:704-916-2108
Mailing Address - Fax:
Practice Address - Street 1:1721 EBENEZER RD STE 175
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1188
Practice Address - Country:US
Practice Address - Phone:804-324-5256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT201295208600000X
NC2021-01921208600000X
SC86393208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery