Provider Demographics
NPI:1902164171
Name:DR. VASANT L. GARDE
Entity Type:Organization
Organization Name:DR. VASANT L. GARDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VASANT
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-564-8803
Mailing Address - Street 1:408 TWO NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-8827
Mailing Address - Country:US
Mailing Address - Phone:803-356-2262
Mailing Address - Fax:803-957-6800
Practice Address - Street 1:120 LOUIE STREET
Practice Address - Street 2:
Practice Address - City:WAGENER
Practice Address - State:SC
Practice Address - Zip Code:29164
Practice Address - Country:US
Practice Address - Phone:803-564-8803
Practice Address - Fax:803-564-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10226261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC102267Medicaid
SCC604570282Medicare UPIN