1114423720 NPI number — DANIEL T DRECHSLER MD

Table of content: DANIEL T DRECHSLER MD (NPI 1114423720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114423720 NPI number — DANIEL T DRECHSLER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DRECHSLER
Provider First Name:
DANIEL
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114423720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 ACADEMY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29646-3869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-725-4865
Provider Business Mailing Address Fax Number:
864-725-4883

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3334 BOYLSTON HWY
Provider Second Line Business Practice Location Address:
STE 20
Provider Business Practice Location Address City Name:
MILLS RIVER
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28759-4103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-694-8150
Provider Business Practice Location Address Fax Number:
828-694-8151
Provider Enumeration Date:
04/03/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  52647 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QS0010X , with the licence number: 2022-01550 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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