Healthcare Provider Details

I. General information

NPI: 1316079262
Provider Name (Legal Business Name): SULOCHANA DEVI CHERUKURI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 10/04/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRODY 3E127 600 MOYE BLVD
GREENVILLE NC
27834-6863
US

IV. Provider business mailing address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-3326
  • Fax:
Mailing address:
  • Phone: 803-540-1000
  • Fax: 803-540-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27862
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number2009-00444
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: