Healthcare Provider Details

I. General information

NPI: 1417509415
Provider Name (Legal Business Name): DARELL CAESARIO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2019
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 W FARIS RD STE D
GREENVILLE SC
29605-4296
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-9031
  • Fax: 864-455-9014
Mailing address:
  • Phone: 864-695-6697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number87738
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: