Provider Demographics
NPI:1639172059
Name:SUGAR, DARRYL M (MD)
Entity Type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:M
Last Name:SUGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:290G APPLEWOOD CENTER PLACE
Mailing Address - Street 2:PMB #310
Mailing Address - City:SENECA
Mailing Address - State:SC
Mailing Address - Zip Code:29678
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
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21529207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3380Medicaid
SCD95004Medicare UPIN