Provider Demographics
NPI:1538134325
Name:KUDCHADKAR, ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:
Last Name:KUDCHADKAR
Suffix:
Gender:M
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:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29180-0479
Mailing Address - Country:US
Mailing Address - Phone:803-635-6411
Mailing Address - Fax:803-712-6651
Practice Address - Street 1:880 W. MOULTRIE ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:WINNSBORO
Practice Address - State:SC
Practice Address - Zip Code:29180
Practice Address - Country:US
Practice Address - Phone:803-635-6411
Practice Address - Fax:803-712-6651
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10531208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC105317Medicaid
SCB91404Medicare UPIN