Healthcare Provider Details

I. General information

NPI: 1710181060
Provider Name (Legal Business Name): KUDCHADKAR CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 WEST MOULTRIE ST SUITE 100
WINNSBORO SC
29180
US

IV. Provider business mailing address

PO BOX 479
WINNSBORO SC
29180-0479
US

V. Phone/Fax

Practice location:
  • Phone: 803-635-6411
  • Fax: 803-712-6651
Mailing address:
  • Phone: 803-635-6411
  • Fax: 803-712-6651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number10853
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number10531
License Number StateSC

VIII. Authorized Official

Name: DR. ANIL J KUDCHDKAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 803-635-6411