Provider Demographics
NPI:1871839605
Name:DANY, ETHEL B (PEDORTHIST,BOCPD)
Entity Type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:B
Last Name:DANY
Suffix:
Gender:F
Credentials:PEDORTHIST,BOCPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BLAIR CIR
Mailing Address - Street 2:P.O.BOX 631
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-3212
Mailing Address - Country:US
Mailing Address - Phone:803-625-4100
Mailing Address - Fax:803-625-4100
Practice Address - Street 1:41 BLAIR CIR
Practice Address - Street 2:41 BLAR CIRCLE
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-3212
Practice Address - Country:US
Practice Address - Phone:803-625-4100
Practice Address - Fax:803-625-4100
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC46785211D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric