Provider Demographics
NPI:1023499076
Name:PATEL, NIKHIL BALDEV (MD)
Entity type:Individual
Prefix:
First Name:NIKHIL
Middle Name:BALDEV
Last Name:PATEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8121 ROURK STREET
Mailing Address - Street 2:ATT: HR/CREDENTIALING
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29572-4128
Mailing Address - Country:US
Mailing Address - Phone:843-692-5000
Mailing Address - Fax:843-692-5010
Practice Address - Street 1:817 FARRAR DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-8747
Practice Address - Country:US
Practice Address - Phone:843-234-1660
Practice Address - Fax:843-234-1661
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPENDING207RH0003X
MST-2998207R00000X
390200000X
SC86266207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01353375Medicaid