Basic Information
| Provider Information | |||||||||
| NPI: | 1043206410 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURLEY | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2834 AQUADUCT ST | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294147410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437661936 | ||||||||
| FaxNumber: | 8437661206 | ||||||||
| Practice Location | |||||||||
| Address1: | 2270 ASHLEY CROSSING DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294145702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437661936 | ||||||||
| FaxNumber: | 8437661206 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2005 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | SC0310 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 3105 | 05 | SC | MEDICAID | GP3558 | 05 | SC | MEDICAID | 043611743 | 01 | SC | FEDERAL ID NUMBER | OTHER |