Provider Demographics
NPI:1447205844
Name:SUMMIT PLASTIC AND HAND SURGERY PA
Entity Type:Organization
Organization Name:SUMMIT PLASTIC AND HAND SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-802-2488
Mailing Address - Street 1:1700 FIRST BAXTER CROSSING
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8954
Mailing Address - Country:US
Mailing Address - Phone:803-802-2488
Mailing Address - Fax:803-802-3352
Practice Address - Street 1:1700 FIRST BAXTER CROSSING
Practice Address - Street 2:SUITE 202
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8954
Practice Address - Country:US
Practice Address - Phone:803-802-2488
Practice Address - Fax:803-802-3352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27384174400000X
SC29738442086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCH05988Medicare UPIN