Provider Demographics
NPI:1639123821
Name:COSHAL, BALBIR S (MD)
Entity Type:Individual
Prefix:
First Name:BALBIR
Middle Name:S
Last Name:COSHAL
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 1:1911 BARNWELL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2605
Mailing Address - Country:US
Mailing Address - Phone:803-771-6500
Mailing Address - Fax:803-834-4920
Practice Address - Street 1:1911 BARNWELL ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2605
Practice Address - Country:US
Practice Address - Phone:803-771-6500
Practice Address - Fax:803-834-4920
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14752174400000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1369Medicaid
SCNP147521Medicaid
SC14752OtherSC MEDICAL LIC #
SC14752OtherSC MEDICAL LIC #
SCNP1369Medicaid