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General NPI Number Information
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NPI Number | 1932177052
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Entity Type | Individual
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Provider Name | SUDIPTA MISRA MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 295A MIDLAND PKWY STE 260
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City | SUMMERVILLE
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State | SC
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Zip | 29485-9039
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Country | US
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Telephone | 843-695-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 295-A MIDLAND PARKWAY
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City | SUMMERVILLE
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State | SC
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Zip | 29485
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 2012-00929
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 036097590
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 51197
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License Number State | SC
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