Individual
SUSAN JO START
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1698 HIGHWAY 160 W, SUITE 220, FORT MILL, SC 29708-8032
(803) 802-5900
(803) 802-7101
Mailing address
1601 EBENEZER RD, ROCK HILL, SC 29732-1808
(803) 328-6281
(803) 981-5136
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22022
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
067TP
BC/BS
NC
05
—
220228
—
SC
Enumeration date
07/07/2006
Last updated
07/08/2007
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