Provider Demographics
NPI:1912119371
Name:PATEL, NANCY (DO)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PATEL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PLAZA CIR
Mailing Address - Street 2:STE N
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-7556
Mailing Address - Country:US
Mailing Address - Phone:864-547-2160
Mailing Address - Fax:864-547-2160
Practice Address - Street 1:700 PLAZA CIR STE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325
Practice Address - Country:US
Practice Address - Phone:864-547-2160
Practice Address - Fax:864-547-2159
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016915207R00000X
SC1571207RC0200X, 207RP1001X
SCD01571207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB851OtherMEDICARE PTAN
SC015717Medicaid
SC015717Medicaid