Healthcare Provider Details

I. General information

NPI: 1356871925
Provider Name (Legal Business Name): RADAMES ADAMO ZUQUELLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3709 MAGNOLIA ST
ORANGEBURG SC
29118-1403
US

IV. Provider business mailing address

3709 MAGNOLIA ST
ORANGEBURG SC
29118-1403
US

V. Phone/Fax

Practice location:
  • Phone: 803-531-2220
  • Fax: 803-531-7975
Mailing address:
  • Phone: 803-531-2220
  • Fax: 803-531-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number86951
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: