Provider Demographics
NPI:1568448561
Name:DAHLHAUSEN, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAMES
Last Name:DAHLHAUSEN
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:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-0919
Mailing Address - Country:US
Mailing Address - Phone:864-897-8280
Mailing Address - Fax:864-897-8281
Practice Address - Street 1:123 WG ACKER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2739
Practice Address - Country:US
Practice Address - Phone:864-878-2435
Practice Address - Fax:864-898-1055
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23327207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT76058Medicaid
SCGP1804Medicaid
SC5664Medicare PIN
SC1135Medicare PIN
SCT76058Medicaid