Healthcare Provider Details

I. General information

NPI: 1750332367
Provider Name (Legal Business Name): DALE E TREASH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 N FANT ST
ANDERSON SC
29621-5705
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-7034
  • Fax: 864-225-0837
Mailing address:
  • Phone: 864-512-7034
  • Fax: 864-225-0837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number22135
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier221352
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 2
Identifier1205935
Identifier TypeOTHER
Identifier State
Identifier IssuerPHYSICIANS CARE NETWORK
# 3
IdentifierS292610
Identifier TypeOTHER
Identifier State
Identifier IssuerHEALTHSOUTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: