Healthcare Provider Details

I. General information

NPI: 1366704694
Provider Name (Legal Business Name): DANIEL WARD MARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W 22ND ST.
SIOUX FALLS SD
57105-1521
US

IV. Provider business mailing address

169 ASHLEY AVE ROOM 202 MAIN HOSPITAL MSC333
CHARLESTON SC
29425-8905
US

V. Phone/Fax

Practice location:
  • Phone: 605-312-1050
  • Fax: 605-312-1008
Mailing address:
  • Phone: 843-792-8972
  • Fax: 843-792-9923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL34855
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number10371
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: