Provider Demographics
NPI:1821265141
Name:CHI, SULENE L (MD)
Entity Type:Individual
Prefix:
First Name:SULENE
Middle Name:L
Last Name:CHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4266
Mailing Address - Country:US
Mailing Address - Phone:864-329-3002
Mailing Address - Fax:864-458-3892
Practice Address - Street 1:601 HALTON
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3403
Practice Address - Country:US
Practice Address - Phone:864-271-3354
Practice Address - Fax:864-250-6443
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SCMMD.36338TL207W00000X
NC141777390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4076260OtherCIGNA/ GREAT WEST
SCQ0079TMedicaid
SCSC2114594Medicare PIN
SC4076260OtherCIGNA/ GREAT WEST