Provider Demographics
NPI:1235189218
Name:COKER, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:COKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 LADSON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-4304
Mailing Address - Country:US
Mailing Address - Phone:843-285-2500
Mailing Address - Fax:843-285-2505
Practice Address - Street 1:3601 LADSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-4304
Practice Address - Country:US
Practice Address - Phone:843-285-2500
Practice Address - Fax:843-285-2505
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9772207RC0000X, 207RI0011X, 207UN0902X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC060067920OtherRAILROAD MEDICARE
SC097727Medicaid
SCB917086493Medicare PIN
SC097727Medicaid