Provider Demographics
NPI:1114958295
Name:DEMCHAK, SUSAN MCBRAYER (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MCBRAYER
Last Name:DEMCHAK
Suffix:
Gender:F
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1656 RIVERCHASE BLVD
Practice Address - Street 2:STE 3600
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-2084
Practice Address - Country:US
Practice Address - Phone:803-324-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300331207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC066NWOtherNC BCBS-ROCK HILL OFFICE
NC1114958295Medicaid
NC89066NWMedicaid
NC134F7OtherNC BCBS-CHARLOTTE NC
SC236596Medicaid
NC89134F7Medicaid
NC2014504AMedicare PIN
NC89066NWMedicaid
NC2014504Medicare PIN
SCH824157165Medicare PIN
NC134F7OtherNC BCBS-CHARLOTTE NC
NC1114958295Medicaid