Provider Demographics
NPI:1841294121
Name:PATI, ASIM RANJAN (MD)
Entity type:Individual
Prefix:DR
First Name:ASIM
Middle Name:RANJAN
Last Name:PATI
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:101 E WOOD ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-7050
Practice Address - Fax:864-560-0800
Is Sole Proprietor?:No
Enumeration Date:2005-06-02
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18442207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1844728Medicaid
SCP00692287OtherRR MEDICARE
SCF729303365OtherMEDICARE PIN
SC7183Medicare PIN
SC830003733Medicare ID - Type UnspecifiedRAILROAD MEDICARE PROVIDE
SCP00692287OtherRR MEDICARE
NC890523QMedicaid
SC5172Medicare PIN
SC6521Medicare PIN
SCF729304746Medicare PIN