Provider Demographics
NPI:1033143409
Name:MCBRYDE, JOHN PETER ROSTAN SR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN PETER
Middle Name:ROSTAN
Last Name:MCBRYDE
Suffix:SR
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 1:7845 LITTLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8198
Mailing Address - Country:US
Mailing Address - Phone:704-375-0100
Mailing Address - Fax:704-375-8623
Practice Address - Street 1:7845 LITTLE AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-8198
Practice Address - Country:US
Practice Address - Phone:704-375-0100
Practice Address - Fax:704-887-6450
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600633207PH0002X, 207PS0010X, 207P00000X
SC24210207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
No207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891013VMedicaid
NC1033143409Medicaid
SCN00635Medicaid
NC1033143409Medicaid
NCG40856Medicare UPIN
NC2233606Medicare PIN
NC2233606HMedicare PIN
SCN00635Medicaid