Healthcare Provider Details

I. General information

NPI: 1922505676
Provider Name (Legal Business Name): DANIEL POOLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CALLEN BLVD STE 330
SUMMERVILLE SC
29486-2816
US

IV. Provider business mailing address

PO BOX 632709
CINCINNATI OH
45263-2709
US

V. Phone/Fax

Practice location:
  • Phone: 843-763-2857
  • Fax: 843-606-8053
Mailing address:
  • Phone: 888-472-0043
  • Fax: 843-724-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number333412
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101279918
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number93979
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number333412
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: