Healthcare Provider Details

I. General information

NPI: 1215996251
Provider Name (Legal Business Name): PHILIP S. SUH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 STUART ST
FORT JACKSON SC
29207-5700
US

IV. Provider business mailing address

4500 STUART ST
FORT JACKSON SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-2191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number01055716A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: