Provider Demographics
NPI:1194817932
Name:SUCHINDA, PUSADEE (MD)
Entity Type:Individual
Prefix:DR
First Name:PUSADEE
Middle Name:
Last Name:SUCHINDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 W WESMARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1900
Mailing Address - Country:US
Mailing Address - Phone:803-469-7500
Mailing Address - Fax:803-469-7519
Practice Address - Street 1:635 W WESMARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-1900
Practice Address - Country:US
Practice Address - Phone:803-469-7500
Practice Address - Fax:803-469-7519
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10273207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10273-9Medicaid
SCC687822293Medicare ID - Type Unspecified
SCC68782Medicare UPIN