Healthcare Provider Details

I. General information

NPI: 1497712285
Provider Name (Legal Business Name): BURKE HOOD DIAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 RICHLAND MEDICAL PARK RD SUITE 310
COLUMBIA SC
29203
US

IV. Provider business mailing address

PO BOX 402145
ATLANTA GA
30384-2145
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-8323
  • Fax: 803-434-8326
Mailing address:
  • Phone: 803-434-8323
  • Fax: 803-434-8326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number8345
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: