Provider Demographics
NPI:1578559860
Name:PATEL, MANISH PRAFULLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
Middle Name:PRAFULLA
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 PINNACLE PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELGIN
Mailing Address - State:SC
Mailing Address - Zip Code:29045-8390
Mailing Address - Country:US
Mailing Address - Phone:803-424-8022
Mailing Address - Fax:803-408-8501
Practice Address - Street 1:40 PINNACLE PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:ELGIN
Practice Address - State:SC
Practice Address - Zip Code:29045-8390
Practice Address - Country:US
Practice Address - Phone:803-424-8022
Practice Address - Fax:803-408-8501
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200270208800000X
SCTL38968208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2008086BMedicare PIN