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General NPI Number Information
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NPI Number | 1982132510
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Entity Type | Individual
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Provider Name | DAREN ALEXANDER FOMIN DO
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Gender | Male
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 10/23/2025
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Provider Practice Location Address
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Address Line | 1409 N FANT ST
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City | ANDERSON
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State | SC
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Zip | 29621-4825
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Country | US
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Telephone | 864-231-8599
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Fax | 864-231-8073
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Provider Business Mailing Address
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Address Line | 1409 N FANT ST
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City | ANDERSON
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State | SC
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Zip | 29621-4825
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Country | US
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Telephone | 864-231-8599
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Fax | 864-231-8073
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 0102205409
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 91371
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 05-44847
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License Number State | KS
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