Healthcare Provider Details

I. General information

NPI: 1659540771
Provider Name (Legal Business Name): DANIEL AB METHUSELAH DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7182 WOODROW ST STE 105
IRMO SC
29063-2832
US

IV. Provider business mailing address

7182 WOODROW ST STE 105
IRMO SC
29063-2832
US

V. Phone/Fax

Practice location:
  • Phone: 803-781-3500
  • Fax: 803-781-2924
Mailing address:
  • Phone: 803-781-3500
  • Fax: 803-781-2924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number517
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number517
License Number StateSC

VIII. Authorized Official

Name: DR. DANIEL AB METHUSELAH
Title or Position: OWNER/ PHYSICIAN
Credential: M.D.
Phone: 803-781-3500