Provider Demographics
NPI:1629037924
Name:CUDDY, BRIAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:G
Last Name:CUDDY
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2145 HENRY TECKLENBURG DR
Practice Address - Street 2:SUITE 220
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5893
Practice Address - Country:US
Practice Address - Phone:843-723-0916
Practice Address - Fax:843-722-8124
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14787207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00803390OtherRAILROAD MEDICARE ID-RSFPN
SCP00648624OtherMEDICARE RAILROAD
SC147870Medicaid
SCF635369223Medicare PIN
SCP00803390OtherRAILROAD MEDICARE ID-RSFPN
SC147870Medicaid