Provider Demographics
NPI:1649243254
Name:HOLDEN, DANIEL JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:HOLDEN
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 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6044
Mailing Address - Fax:
Practice Address - Street 1:103 OMNI DR
Practice Address - Street 2:SUITE A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9448
Practice Address - Country:US
Practice Address - Phone:864-885-7886
Practice Address - Fax:864-885-7890
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35046721207RR0500X
SC30421207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC304218Medicaid
SCAA2433OtherMEDICARE PTAN
SCGP4697Medicaid
OH0465830Medicaid
OH0465830Medicaid
SC8768Medicare PIN