Organization
COASTAL KIDNEY CENTER PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SIVANTHAN BALACHANDRAN MD (PRESIDENT)
(843) 347-9487
Entity
Organization
Contact information
Practice address
847 FARRAR DRIVE, CONWAY, SC 29526
(843) 347-9487
(843) 347-9574
Mailing address
847 FARRAR DRIVE, CONWAY, SC 29526
(843) 347-9487
(843) 347-9574
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
17448
SC
207RN0300X
Nephrology Physician
22373
SC
207RN0300X
Nephrology Physician
985
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
=========
BCBS
SC
05
—
GP1049
—
SC
Enumeration date
11/21/2006
Last updated
09/25/2024
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