Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 20291 | SC |
Y | 207Q00000X | Family Doctor | 20291 | SC |
NPI | 1124068945 |
---|---|
Provider Name | Dr. Sudesh H Kedar |
First Address | Lancaster, SC 29720-1709 |
Second Address | Lancaster, SC 29720-1709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 03/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G81955 | (02) | SC |
GP2990 | (05) | SC |