Provider Demographics
NPI:1710181060
Name:KUDCHADKAR CLINIC
Entity Type:Organization
Organization Name:KUDCHADKAR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUDCHDKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-635-6411
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 WEST 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC108532080A0000X
SC105312086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC105317Medicaid
SC108537Medicaid
SC2343Medicare ID - Type Unspecified
SC108537Medicaid
SCD74156Medicare UPIN