Healthcare Provider Details

I. General information

NPI: 1194219741
Provider Name (Legal Business Name): DAN T LAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DAN THE LAM

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12016 N RADIO STATION RD
SENECA SC
29678-1143
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 864-882-6141
  • Fax: 864-882-6680
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number52825
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: