Healthcare Provider Details

I. General information

NPI: 1982232021
Provider Name (Legal Business Name): DYLAN OLIVER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 BLACK RIVER RD
GEORGETOWN SC
29440-3304
US

IV. Provider business mailing address

PO BOX 23321
NEW YORK NY
10087-3321
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-1414
  • Fax:
Mailing address:
  • Phone: 843-792-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number96941
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: