Provider Demographics
NPI:1043473895
Name:SUWAN, PHILLIP T (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:T
Last Name:SUWAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:410 UNIVERSITY PKWY STE 2600
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-6829
Mailing Address - Country:US
Mailing Address - Phone:803-293-1424
Mailing Address - Fax:803-293-1523
Practice Address - Street 1:410 UNIVERSITY PKWY STE 2600
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6829
Practice Address - Country:US
Practice Address - Phone:803-644-4264
Practice Address - Fax:803-293-1523
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125-055461207Y00000X
SC52097208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology