1356652283 NPI number — DR. VISHAL ABIRAJ MBBS

Table of content: DR. VISHAL ABIRAJ MBBS (NPI 1356652283)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356652283 NPI number — DR. VISHAL ABIRAJ MBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABIRAJ
Provider First Name:
VISHAL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MBBS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356652283
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 MCGEE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAMBERG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29003-1154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-956-6100
Provider Business Mailing Address Fax Number:
803-632-1209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 MCGEE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAMBERG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29003-1154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-956-6100
Provider Business Practice Location Address Fax Number:
803-632-1209
Provider Enumeration Date:
06/25/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  36549 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 365492 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36549 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: SC3469 . This is a "MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".