Basic Information
| Provider Information | |||||||||
| NPI: | 1366440356 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DILLMAN | ||||||||
| FirstName: | MITCHELL | ||||||||
| MiddleName: | FOY | ||||||||
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| Credential: | M. D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 E MCBEE AVE FL 4 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296012842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645222286 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11082 N RADIO STATION RD | ||||||||
| Address2: | |||||||||
| City: | SENECA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296781142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648822314 | ||||||||
| FaxNumber: | 8648823677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 05/19/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 14485 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | GP4697 | 05 | SC | MEDICAID | TL5943 | 05 | SC | MEDICAID | 080028018 | 01 | SC | RAILROAD MEDICARE | OTHER |