=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588679146
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DARRYL M SUGAR MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 02/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 135 PROFESSIONAL PARK DR
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29678-2558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-482-3773
-----------------------------------------------------
Fax | 864-482-3299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 290 APPLEWOOD CENTER PL STE G PMB #310
-----------------------------------------------------
City | SENECA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29678-0930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-482-3773
-----------------------------------------------------
Fax | 864-482-3299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | SHIRLEY SUGAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-482-3773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 21529
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------