Provider Demographics
NPI:1457306136
Name:PATEL, SIDHARTH C (MD)
Entity Type:Individual
Prefix:
First Name:SIDHARTH
Middle Name:C
Last Name:PATEL
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 1:110 PERPETUAL SQUARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-261-9888
Mailing Address - Fax:864-226-0407
Practice Address - Street 1:110 PERPETUAL SQUARE DRIVE
Practice Address - Street 2:PARADIGM MEDICAL SERVICES PC
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-261-9888
Practice Address - Fax:864-226-0407
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12767207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC127678Medicaid
SCGP1988Medicaid
SCGP1988Medicaid