Provider Demographics
NPI:1346291325
Name:SATTERWHITE, BRYAN C
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:C
Last Name:SATTERWHITE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4428 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-4450
Mailing Address - Country:US
Mailing Address - Phone:910-755-3338
Mailing Address - Fax:910-754-3335
Practice Address - Street 1:4428 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-4450
Practice Address - Country:US
Practice Address - Phone:910-755-3338
Practice Address - Fax:910-754-3335
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC432213ES0131X, 213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890804VMedicaid
NC890804VMedicaid
NC2433614BMedicare ID - Type Unspecified
NC5108190001Medicare NSC