Basic Information
| Provider Information | |||||||||
| NPI: | 1497983399 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEMETH | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | NEMETH | ||||||||
| OtherFirstName: | DANIEL | ||||||||
| OtherMiddleName: | STEPHEN | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | JR. | ||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 929 BOWMAN RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294643237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437304124 | ||||||||
| FaxNumber: | 8438064295 | ||||||||
| Practice Location | |||||||||
| Address1: | 929 BOWMAN RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | MOUNT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294643237 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437304124 | ||||||||
| FaxNumber: | 8438064295 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD37319 | SC | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0210694 | 01 | SC | CIGNA PROVIDER ID | OTHER | 373198 | 05 | SC | MEDICAID | 30225615 | 01 | SC | SELECT HEALTH OF SC PROVIDER ID | OTHER | 1500963 | 01 | SC | WELLCARE PROVIER ID | OTHER | 9016994 | 01 | SC | AETNA PROVIDER PIN | OTHER | 1684256 | 01 | SC | COVENTRY HEALTHCARE PROVIDER ID | OTHER | GP6337 | 01 | SC | GROUP MEDICAID | OTHER |