Provider Demographics
NPI:1669582797
Name:CARDUCCI, BRYAN (MD)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:CARDUCCI
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 32003
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27622-2003
Mailing Address - Country:US
Mailing Address - Phone:919-782-0479
Mailing Address - Fax:
Practice Address - Street 1:18167 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 285
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-3528
Practice Address - Country:US
Practice Address - Phone:919-782-0479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-01260207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA15337Medicare UPIN