Healthcare Provider Details

I. General information

NPI: 1952310716
Provider Name (Legal Business Name): SUDAN DEUSKAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 ELMS CENTRE RD
N CHARLESTON SC
29406-9844
US

IV. Provider business mailing address

PO BOX 118008
CHARLESTON SC
29423-8008
US

V. Phone/Fax

Practice location:
  • Phone: 843-572-7727
  • Fax: 843-569-5872
Mailing address:
  • Phone: 843-572-7727
  • Fax: 843-569-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberME198360
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License NumberME198360
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberME198360
License Number StateSC
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME198360
License Number StateSC
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME198360
License Number StateSC
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberME198360
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: