MEDICARE: SUDAN DEUSKAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085B0100X	Body Imaging Physician	ME198360	SC
2	2085N0904X	Nuclear Radiology Physician	ME198360	SC
3	2085P0229X	Pediatric Radiology Physician	ME198360	SC
4	2085R0202X	Diagnostic Radiology Physician	ME198360	SC
5	2085R0204X	Vascular & Interventional Radiology Physician	ME198360	SC
6	2085U0001X	Diagnostic Ultrasound Physician	ME198360	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00689235	OTHER	SC	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952310716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUDAN DEUSKAR MD

Provider Business Mailing Address
First Line	:	PO BOX 118008
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29423-8008
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:	843-569-5881

Provider Business Practice Location Address
First Line	:	2550 ELMS CENTRE RD
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9844
Country	:	US
Telephone Number	:	843-572-7727
Fax Number	:	843-569-5872

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	03/06/2013

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Directions to “ SUDAN DEUSKAR MD” Practice Location

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