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NPI Code Detail

MEDICARE: DJB MD LLC

MEDICARE: DJB MD LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner
22084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1366941148
Entity Type Code : Organization
Provider Name (Legal Business Name) : DJB MD LLC
Provider Business Mailing Address
First Line : 115 FAIRCHILD ST STE 170
Second Line :
City : DANIEL ISLAND
State : SC
Zip : 29492-7602
Country : US
Telephone Number : 803-339-1563
Fax Number : 803-746-7902
Provider Business Practice Location Address
First Line : 115 FAIRCHILD ST STE 170
Second Line :
City : DANIEL ISLAND
State : SC
Zip : 29492-7602
Country : US
Telephone Number : 803-339-1563
Fax Number : 803-746-7902
Authorized Official
Title or Position : DIRECTOR
Name : DANIEL J. BALOG
Credential : MD
Telephone Number : 803-339-1563
Provider Enumeration Date : 02/07/2018
Last Update Date : 04/10/2025

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Directions to “DJB MD LLC ” Practice Location

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