Provider Demographics
NPI:1801876446
Name:DANIEL PISTONE MD PA
Entity type:Organization
Organization Name:DANIEL PISTONE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:PISTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-234-2335
Mailing Address - Street 1:PO BOX 656
Mailing Address - Street 2:
Mailing Address - City:TABOR CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28463-0656
Mailing Address - Country:US
Mailing Address - Phone:843-234-2335
Mailing Address - Fax:
Practice Address - Street 1:3185 WILDHORSE DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-7817
Practice Address - Country:US
Practice Address - Phone:843-234-2335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC268582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4324Medicaid
SC2003467OtherCIGNA
SCD9836OtherMEDCOST
SCN01445Medicaid
SC9344735OtherPRIVATE HEALTHCARE
SCN01445Medicaid
SC8086Medicare PIN