Provider Demographics
NPI:1376812651
Name:HY SUSSMAN, MD
Entity Type:Organization
Organization Name:HY SUSSMAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HY
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-384-6256
Mailing Address - Street 1:PO BOX 21919
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29925
Mailing Address - Country:US
Mailing Address - Phone:843-717-4286
Mailing Address - Fax:843-717-9349
Practice Address - Street 1:14 WESTBURY PARK, SUITE 103
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7461
Practice Address - Country:US
Practice Address - Phone:843-384-6256
Practice Address - Fax:706-364-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-15
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6890207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA743Medicaid
GA000020039LMedicaid
GA390007139OtherMEDICARE RR
SC903035Medicaid
SC903035Medicaid
D42161Medicare UPIN
GA39BDCBKMedicare PIN