Basic Information
| Provider Information | |||||||||
| NPI: | 1952310716 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEUSKAR | ||||||||
| FirstName: | SUDAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 118008 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294238008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435727727 | ||||||||
| FaxNumber: | 8435695881 | ||||||||
| Practice Location | |||||||||
| Address1: | 2550 ELMS CENTRE RD | ||||||||
| Address2: | |||||||||
| City: | N CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294069844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8435727727 | ||||||||
| FaxNumber: | 8435695872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 03/06/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085B0100X | ME198360 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Body Imaging | 2085N0904X | ME198360 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085P0229X | ME198360 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | 2085R0202X | ME198360 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | ME198360 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | ME198360 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
ID Information
| ID | Type | State | Issuer | Description | GP1551 | 01 | SC | MEDICAID GROUP | OTHER | GP5367 | 01 | SC | MEDICAID GROUP | OTHER | GP2858 | 01 | SC | MEDICAID GROUP | OTHER | 198360 | 05 | SC | MEDICAID | P00689235 | 01 | SC | MEDICARE RR | OTHER | GP2906 | 01 | SC | MEDICAID GROUP | OTHER | GP3659 | 01 | SC | MEDICAID GROUP | OTHER | GP5421 | 01 | SC | MEDICAID GROUP | OTHER |