1952310716 NPI number — SUDAN DEUSKAR MD

Table of content: SUDAN DEUSKAR MD (NPI 1952310716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952310716 NPI number — SUDAN DEUSKAR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEUSKAR
Provider First Name:
SUDAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1952310716
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 118008
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLESTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29423-8008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-572-7727
Provider Business Mailing Address Fax Number:
843-569-5881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2550 ELMS CENTRE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N CHARLESTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29406-9844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-572-7727
Provider Business Practice Location Address Fax Number:
843-569-5872
Provider Enumeration Date:
08/07/2006

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: 2085B0100X , with the licence number:  ME198360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: ME198360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: ME198360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: ME198360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0204X , with the licence number: ME198360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: ME198360 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: GP1551 . This is a "MEDICAID GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP5367 . This is a "MEDICAID GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP2858 . This is a "MEDICAID GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 198360 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00689235 . This is a "MEDICARE RR" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP2906 . This is a "MEDICAID GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP3659 . This is a "MEDICAID GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: GP5421 . This is a "MEDICAID GROUP" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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