Individual
NACHIKET NITIN DATAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
809 82ND PARKWAY GRAND STRAND MEDICAL CENTER/, GME OFFICE, MYRTLE BEACH, SC 29572
(843) 848-4679
(843) 848-4682
Mailing address
809 82ND PARKWAY GRAND STRAND MEDICAL CENTER/, GME OFFICE, MYRTLE BEACH, SC 29572
(843) 848-4679
(843) 848-4682
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2021030733
MO
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2018
Last updated
11/04/2021
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