Healthcare Provider Details

I. General information

NPI: 1639175516
Provider Name (Legal Business Name): KEVIN MICHAEL DINEEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E SUITE 340
LITTLE RIVER SC
29566-8163
US

IV. Provider business mailing address

PO BOX 3239
FLORENCE SC
29502-3239
US

V. Phone/Fax

Practice location:
  • Phone: 843-390-8302
  • Fax: 843-390-8315
Mailing address:
  • Phone: 843-366-3729
  • Fax: 843-777-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20319
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number20319
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number20319
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: