Provider Demographics
NPI:1841388956
Name:MERCY OB GYN
Entity type:Organization
Organization Name:MERCY OB GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAGESH
Authorized Official - Middle Name:DAHYALAL
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:864-288-3100
Mailing Address - Street 1:274 COMMONWEALTH DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4869
Mailing Address - Country:US
Mailing Address - Phone:864-288-3100
Mailing Address - Fax:864-288-3004
Practice Address - Street 1:274 COMMONWEALTH DR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4869
Practice Address - Country:US
Practice Address - Phone:864-288-3100
Practice Address - Fax:864-288-3004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17808207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0704786OtherPPO - CAROLINA CARE PLAN
SC88449OtherHMO - MEDCOST PREFFERED
SCGP2403Medicaid
SCGP2403Medicaid
SC=========OtherBCBS & COMMERCIAL INSURAN