Provider Demographics
NPI:1841211687
Name:MADANI, NAVID (MD)
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:MADANI
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 1:29 TOWNPARK CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2676
Mailing Address - Country:US
Mailing Address - Phone:803-567-9626
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-01419207RG0100X
CAC51729207RG0100X
SC22719207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT69404Medicaid
SCP00691991OtherRR MC PIN
SCP01044470OtherRAILROAD MEDICARE
SCP01044470OtherRAILROAD MEDICARE
SCH412897104Medicare PIN
SCAA82407951Medicare PIN