Provider Demographics
NPI:1659353811
Name:DAS, SUSHIL KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSHIL
Middle Name:KUMAR
Last Name:DAS
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 1:1410 SNYDER ST
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-7721
Mailing Address - Country:US
Mailing Address - Phone:803-324-7777
Mailing Address - Fax:803-324-8787
Practice Address - Street 1:1787 EBENEZER RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1101
Practice Address - Country:US
Practice Address - Phone:803-324-7777
Practice Address - Fax:803-324-8787
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18689207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT27986Medicaid
SCG41904AMedicare UPIN
SCT27986Medicaid
SCT27986Medicaid