Provider Demographics
NPI:1659540771
Name:DANIEL AB METHUSELAH DPM LLC
Entity Type:Organization
Organization Name:DANIEL AB METHUSELAH DPM LLC
Other - Org Name:CAROLINA PODIATRIC MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AB
Authorized Official - Last Name:METHUSELAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-781-3500
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC517213ES0103X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC480027811OtherRAILROAD MEDICARE
SCU68192Medicare UPIN