Healthcare Provider Details

I. General information

NPI: 1285611525
Provider Name (Legal Business Name): DINA V HUNTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 BARNWELL ST
COLUMBIA SC
29201-2641
US

IV. Provider business mailing address

1709 BARNWELL ST
COLUMBIA SC
29201-2641
US

V. Phone/Fax

Practice location:
  • Phone: 803-254-3376
  • Fax: 803-254-3883
Mailing address:
  • Phone: 803-254-3376
  • Fax: 803-254-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number13534
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberH2877
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: