Individual
SUCHITA SHIRISH PANCHOLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2 MEDICAL PARK RD STE 203, COLUMBIA, SC 29203-6839
(803) 545-5444
(803) 933-3042
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-7330
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2014-00900
NC
207R00000X
Internal Medicine Physician
Primary
61210
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144516386
—
NC
01
—
18652
BCBS NC
NC
05
—
612108
—
SC
Enumeration date
06/27/2011
Last updated
07/13/2020
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