Individual
SUDIPTA MISRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
295A MIDLAND PKWY STE 260, SUMMERVILLE, SC 29485-9039
(843) 695-2700
Mailing address
295-A MIDLAND PARKWAY, SUMMERVILLE, SC 29485
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
036097590
IL
2080P0206X
Pediatric Gastroenterology Physician
2012-00929
NC
2080P0206X
Pediatric Gastroenterology Physician
Primary
51197
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036097890
—
IL
01
—
07215036
BCBS
IL
01
—
171H6
BCBSNC
NC
05
—
5921082
—
NC
05
—
G59563
—
SC
01
—
IL01Y9
JOHN DEERE
IL
Enumeration date
03/14/2006
Last updated
03/17/2018
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