Provider Demographics
NPI:1285736702
Name:DILLON, JAMES DANIEL JR (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DANIEL
Last Name:DILLON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:367 S GULPH RD
Mailing Address - Street 2:ATTN IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-502-9400
Mailing Address - Fax:803-641-7015
Practice Address - Street 1:410 UNIVERSITY PKWY STE 1520
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6840
Practice Address - Country:US
Practice Address - Phone:803-502-8400
Practice Address - Fax:803-641-7015
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC632617174400000X
SC32617207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10372771Medicaid
SC326178Medicaid
VA10372771Medicaid
SC326178Medicaid
SCAA62569636Medicare PIN