Basic Information
| Provider Information | |||||||||
| NPI: | 1689306086 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COUPER | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | RYAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 169 ASHLEY AVENUE, ROOM 202 MAIN HOSPITAL | ||||||||
| Address2: | MSC333 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 29425 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 167 ASHLEY AVE | ||||||||
| Address2: | SUITE 301, MSC 912 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294259120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8437922322 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2022 | ||||||||
| LastUpdateDate: | 06/26/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 320944 | SC | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.