Provider Demographics
NPI:1003202565
Name:ANDERSON, DANIEL ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ALEXANDER
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 MEMORIAL MEDICAL CT
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-4449
Mailing Address - Country:US
Mailing Address - Phone:864-295-3492
Mailing Address - Fax:864-295-4817
Practice Address - Street 1:8 MEMORIAL MEDICAL CT
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4449
Practice Address - Country:US
Practice Address - Phone:764-295-3492
Practice Address - Fax:864-295-4817
Is Sole Proprietor?:No
Enumeration Date:2015-04-11
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29425207ZP0102X
SC898997207ZP0102X
MDD86090207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD86090OtherLICENSE