Healthcare Provider Details

I. General information

NPI: 1588679146
Provider Name (Legal Business Name): DARRYL M SUGAR MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PROFESSIONAL PARK DR
SENECA SC
29678-2558
US

IV. Provider business mailing address

290 APPLEWOOD CENTER PL STE G PMB #310
SENECA SC
29678-0930
US

V. Phone/Fax

Practice location:
  • Phone: 864-482-3773
  • Fax: 864-482-3299
Mailing address:
  • Phone: 864-482-3773
  • Fax: 864-482-3299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number21529
License Number StateSC

VIII. Authorized Official

Name: SHIRLEY SUGAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 864-482-3773