1982608469 NPI number — DR. MUKESH M GANDHI M.D.

Table of content: DR. MUKESH M GANDHI M.D. (NPI 1982608469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982608469 NPI number — DR. MUKESH M GANDHI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANDHI
Provider First Name:
MUKESH
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1982608469
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 E GEORGIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODRUFF
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29388-1915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-476-7068
Provider Business Mailing Address Fax Number:
864-476-7069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 E GEORGIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODRUFF
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29388-1915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-476-7068
Provider Business Practice Location Address Fax Number:
864-476-7069
Provider Enumeration Date:
06/13/2005

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: 207R00000X , with the licence number:  14842 , 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: 1851467203 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 148423 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 570958219 . This is a "BC/BS" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: DF4780 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: E691833365 . This is a "MEDICARE PTAN" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 570958219 . This is a "TAX IDENTIFICATION NUMBER" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 110121586 . This is a "RR MEDICARE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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