Provider Demographics
NPI:1982132510
Name:FOMIN, DAREN (DO)
Entity type:Individual
Prefix:DR
First Name:DAREN
Middle Name:
Last Name:FOMIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4825
Mailing Address - Country:US
Mailing Address - Phone:864-231-8599
Mailing Address - Fax:864-231-8073
Practice Address - Street 1:1409 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4825
Practice Address - Country:US
Practice Address - Phone:864-231-8599
Practice Address - Fax:864-231-8073
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102205409207N00000X
KS05-44847207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology