Provider Demographics
NPI:1164538732
Name:DEBROY, SUMITA KUMARI (MD)
Entity Type:Individual
Prefix:DR
First Name:SUMITA
Middle Name:KUMARI
Last Name:DEBROY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SUMITA
Other - Middle Name:
Other - Last Name:BANIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2713 DANTZLER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9005
Mailing Address - Country:US
Mailing Address - Phone:843-764-1722
Mailing Address - Fax:843-764-1788
Practice Address - Street 1:2713 DANTZLER DR
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9005
Practice Address - Country:US
Practice Address - Phone:843-764-1722
Practice Address - Fax:843-764-1788
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC293195208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC293195Medicaid
SC293195Medicaid
SCAA1903Medicare UPIN