Provider Demographics
NPI:1952310716
Name:DEUSKAR, SUDAN (MD)
Entity Type:Individual
Prefix:
First Name:SUDAN
Middle Name:
Last Name:DEUSKAR
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 118008
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29423-8008
Mailing Address - Country:US
Mailing Address - Phone:843-572-7727
Mailing Address - Fax:843-569-5881
Practice Address - Street 1:2550 ELMS CENTRE RD
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9844
Practice Address - Country:US
Practice Address - Phone:843-572-7727
Practice Address - Fax:843-569-5872
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCME1983602085B0100X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1551OtherMEDICAID GROUP
SCGP5367OtherMEDICAID GROUP
SCGP2858OtherMEDICAID GROUP
SC198360Medicaid
SCP00689235OtherMEDICARE RR
SCGP2906OtherMEDICAID GROUP
SCGP3659OtherMEDICAID GROUP
SCGP5421OtherMEDICAID GROUP
SCF827706834Medicare PIN
SCGP3659OtherMEDICAID GROUP
SCF827707126Medicare PIN
SCGP2906OtherMEDICAID GROUP
SCGP2858OtherMEDICAID GROUP
SCGP5421OtherMEDICAID GROUP
SCAA67656868Medicare PIN