Provider Demographics
NPI:1457464471
Name:MASINDET, SARBABI (MD)
Entity Type:Individual
Prefix:
First Name:SARBABI
Middle Name:
Last Name:MASINDET
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 22553
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29413-2553
Mailing Address - Country:US
Mailing Address - Phone:843-766-2011
Mailing Address - Fax:843-766-2004
Practice Address - Street 1:1812 WALLACE SCHOOL RD STE 300
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4516
Practice Address - Country:US
Practice Address - Phone:843-766-2011
Practice Address - Fax:843-766-2004
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17874174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC178747Medicaid
SC178747Medicaid