Basic Information
| Provider Information | |||||||||
| NPI: | 1326331885 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEAN | ||||||||
| FirstName: | DOUGLAS | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6439 GARNERS FERRY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6439 GARNERS FERRY RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292091638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037764000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2011 | ||||||||
| LastUpdateDate: | 09/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| NPICertificationDate: | 09/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 0102204560 | VA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208100000X | 0102204560 | VA | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 1326331885 | 01 | VA | VIRGINIA PREMIER HEALTH PLAN | OTHER | 1326331885 | 05 | NC | MEDICAID | 1326331885 | 01 | VA | HUMANA | OTHER | 1326331885 | 01 | VA | ANTHEM BC/BS | OTHER | 1326331885 | 05 | VA | MEDICAID | 1326331885 | 01 | VA | AETNA | OTHER | 1326331885 | 01 | VA | TRICARE/CHAMPUS | OTHER | 1326331885 | 01 | VA | MULTIPLAN | OTHER | 1326331885 | 01 | VA | CIGNA | OTHER | 1326331885 | 01 | VA | UNITED HEALTHCARE | OTHER | 1326331885 | 01 | VA | CORVEL | OTHER | 1326331885 | 01 | VA | COVENTRY HEALTH CARE | OTHER | 1326331885 | 01 | VA | OPTIMA HEALTH | OTHER | 1326331885 | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 1326331885 | 01 | VA | USA MANAGED CARE | OTHER |