Provider Demographics
NPI:1891771804
Name:PATEL, SUBHASHCHANDRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHASHCHANDRA
Middle Name:J
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SUBHASH
Other - Middle Name:J
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2022
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-2022
Mailing Address - Country:US
Mailing Address - Phone:803-936-7966
Mailing Address - Fax:803-936-7938
Practice Address - Street 1:146 N HOSPITAL DR
Practice Address - Street 2:STE 350
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-7966
Practice Address - Fax:803-936-7938
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10450174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC104504Medicaid
SC104504Medicaid
SCE97925Medicare UPIN