DR. DANIEL BORAM PARK M.D.
NPI 1730317397
Pediatrics - Pediatric Emergency Medicine in Charleston, SC

Q: What is the provider's specialty?

The provider's specialty is Pediatrics with taxonomy code 2080P0204X and a focus in Pediatric Emergency Medicine.

Active since June 22, 2009PECOS EnrolledAccepts Medicare Assignment

171 ASHLEY AVE, CHARLESTON, SC 29425(843) 792-1414 Get Directions Write a Review

NPPES record last updated: January 18, 2017. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Dr. Daniel Boram Park M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. DANIEL BORAM PARK M.D. (NPI 1730317397) is an individual pediatric emergency medicine provider in Charleston, South Carolina, licensed in South Carolina (34501) and active in the NPI registry since June 2009. He is enrolled in Medicare PECOS and is a graduate of Virginia Commonwealth University, School Of Medicine (2009).

NPPES Registry Identity

NPI1730317397

Entity TypeIndividualMale

Primary Taxonomy2080P0204X

Provider Legal NameDR. DANIEL BORAM PARKCredential: M.D.

Location Address171 ASHLEY AVECharleston, SC 29425-8908

Mailing AddressPo Box 751461Charlotte, NC 28275-1461 · (843) 792-6200

Phone(843) 792-1414

Sole ProprietorNo

Medical School CMSVirginia Commonwealth University, School Of MedicineGraduated 2009

Enumeration DateJune 22, 2009

Last NPPES UpdateJanuary 18, 2017

✔ NPI 1730317397 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPediatrics · Pediatric Emergency MedicineAllopathic & Osteopathic Physicians

Taxonomy Code2080P0204X

License✔ Licensed in SC · 34501

Definition

A pediatrician who has special qualifications to manage emergencies in infants and children.

Also ListedPediatricsTaxonomy 208000000X · License 34501 (SC)

Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X

171 ASHLEY AVE, Charleston, SC 29425

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Daniel Boram Park M.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5092950899

PECOS Enrollment IDI20160815000759

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.