Provider Demographics
NPI:1588679146
Name:DARRYL M SUGAR MD
Entity Type:Organization
Organization Name:DARRYL M SUGAR MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-482-3773
Mailing Address - Street 1:290 APPLEWOOD CENTER PL STE G
Mailing Address - Street 2:PMB #310
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678-0930
Mailing Address - Country:US
Mailing Address - Phone:864-482-3773
Mailing Address - Fax:864-482-3299
Practice Address - Street 1:135 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-2558
Practice Address - Country:US
Practice Address - Phone:864-482-3773
Practice Address - Fax:864-482-3299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21529207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT56971Medicaid
SCT56971Medicaid