Provider Demographics
NPI:1588631717
Name:BIJOOR, NIVEDITA S (MD)
Entity Type:Individual
Prefix:DR
First Name:NIVEDITA
Middle Name:S
Last Name:BIJOOR
Suffix:
Gender:F
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 12308
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29612-0308
Mailing Address - Country:US
Mailing Address - Phone:864-327-0444
Mailing Address - Fax:864-327-0555
Practice Address - Street 1:215 BATESVILLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-4816
Practice Address - Country:US
Practice Address - Phone:864-627-0444
Practice Address - Fax:864-627-0555
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCB24857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
192950OtherMEDCOST
NC5903806Medicaid
7373610OtherAETNA
SC248574Medicaid
20051866OtherSELECT HEALTH
NC5903806Medicaid
SCAA31059070Medicare PIN
AA05816067Medicare PIN
SC248574Medicaid
SCP00425311Medicare PIN
SCP00318952Medicare PIN
AA05818510Medicare PIN