Healthcare Provider Details

I. General information

NPI: 1376592972
Provider Name (Legal Business Name): TRIDENT CARDIOLOGY ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 LADSON RD SUITE 100
LADSON SC
29456-4304
US

IV. Provider business mailing address

3601 LADSON RD SUITE 100
LADSON SC
29456-4304
US

V. Phone/Fax

Practice location:
  • Phone: 843-285-2500
  • Fax: 843-285-2505
Mailing address:
  • Phone: 843-285-2500
  • Fax: 843-285-2505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A COKER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 843-285-2500