Basic Information
| Provider Information | |||||||||
| NPI: | 1366704694 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARK | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | WARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 ASHLEY AVE | ||||||||
| Address2: | ROOM 202 MAIN HOSPITAL MSC333 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294258905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437928972 | ||||||||
| FaxNumber: | 8437929923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W 22ND ST. | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053121050 | ||||||||
| FaxNumber: | 6053121008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2012 | ||||||||
| LastUpdateDate: | 04/04/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | LL34855 | SC | N | Allopathic & Osteopathic Physicians | Pediatrics | 2080H0002X | 10371 | SD | Y | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine |
No ID Information.