Provider Demographics
NPI:1104129790
Name:PRIOLEAU, TRENTEN A (DPM)
Entity type:Individual
Prefix:
First Name:TRENTEN
Middle Name:A
Last Name:PRIOLEAU
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 HARDEN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-1800
Mailing Address - Country:US
Mailing Address - Phone:803-744-0540
Mailing Address - Fax:803-217-0026
Practice Address - Street 1:1228 HARDEN ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-1800
Practice Address - Country:US
Practice Address - Phone:803-744-0540
Practice Address - Fax:803-217-0026
Is Sole Proprietor?:No
Enumeration Date:2010-12-21
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC613213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist