Provider Demographics
NPI:1093777310
Name:ISEMAN, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:ISEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 TAYLOR ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2901
Mailing Address - Country:US
Mailing Address - Phone:803-509-5710
Mailing Address - Fax:803-509-5711
Practice Address - Street 1:1520 TAYLOR ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2901
Practice Address - Country:US
Practice Address - Phone:803-509-5710
Practice Address - Fax:803-509-5711
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL28664207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01077732OtherMEDICARE RAILROAD
SC286648Medicaid
SCGP5735Medicaid
SCP01385444OtherMEDICARE RAILROAD
SCA270Medicare PIN
SC4000Medicare PIN
SCP01385444OtherMEDICARE RAILROAD
SCI08809A890Medicare PIN