Healthcare Provider Details

I. General information

NPI: 1447205844
Provider Name (Legal Business Name): SUMMIT PLASTIC AND HAND SURGERY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 FIRST BAXTER CROSSING SUITE 202
FORT MILL SC
29708-8954
US

IV. Provider business mailing address

1700 FIRST BAXTER CROSSING SUITE 202
FORT MILL SC
29708-8954
US

V. Phone/Fax

Practice location:
  • Phone: 803-802-2488
  • Fax: 803-802-3352
Mailing address:
  • Phone: 803-802-2488
  • Fax: 803-802-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number27384
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number2973844
License Number StateSC

VIII. Authorized Official

Name: MOHAN PILLAI
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 803-802-2488