Provider Demographics
NPI:1639179138
Name:STRUNJAS, SASA (MD)
Entity Type:Individual
Prefix:
First Name:SASA
Middle Name:
Last Name:STRUNJAS
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 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 E HOSPITAL DR STE 120A
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY362002084P0800X
OH350814992084P0800X
IN10153479A2084P0800X
GA0664262084P0800X
SC846582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200323280Medicaid
GAP01205602OtherRAILROAD MEDICARE
OH2439632Medicaid
GA003133716AMedicaid
KY64076839Medicaid
SCGA1440Medicaid
H33419Medicare UPIN
KY3313236Medicare PIN
GAP01205602OtherRAILROAD MEDICARE
OH2439632Medicaid
GA003133716AMedicaid
KY0655039Medicare PIN
KY64076839Medicaid
IN226420AMedicare PIN