Organization
CAROLINA CARDIOLOGY AND VASCULAR ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL P BOUKNIGHT MD (PRESIDENT/OWNER)
(803) 888-2282
Entity
Organization
Contact information
Practice address
1 WELLNESS BLVD STE 106, IRMO, SC 29063-2872
(803) 888-2282
Mailing address
1 WELLNESS BLVD STE 106, IRMO, SC 29063-2872
(180) 388-8228
(803) 888-2299
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
17456
SC
207RI0011X
Interventional Cardiology Physician
17456
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1427057009
DR. DANIEL BOUKNIGHT INDIVIDUAL NPI
—
01
—
17456
SC LICENSE
SC
05
—
174563
—
SC
Enumeration date
03/13/2018
Last updated
06/27/2022
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