Provider Demographics
NPI:1093760241
Name:METHUSELAH, DANIEL AB (DPM)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:AB
Last Name:METHUSELAH
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:7182 WOODROW ST STE 105
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-2832
Mailing Address - Country:US
Mailing Address - Phone:803-781-3500
Mailing Address - Fax:803-781-2924
Practice Address - Street 1:7182 WOODROW ST STE 105
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2832
Practice Address - Country:US
Practice Address - Phone:803-781-3500
Practice Address - Fax:803-781-2924
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC0517213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
480027811OtherRAILROAD MEDICARE
SCU68192Medicare UPIN