Healthcare Provider Details

I. General information

NPI: 1629088653
Provider Name (Legal Business Name): SETH CHARLES BRODY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 NEW BERN AVE SUITE 306 - OB/GYN
RALEIGH NC
27610-1247
US

IV. Provider business mailing address

3024 NEW BERN AVE SUITE 300
RALEIGH NC
27610-1247
US

V. Phone/Fax

Practice location:
  • Phone: 919-350-8535
  • Fax: 919-350-8310
Mailing address:
  • Phone: 919-350-8228
  • Fax: 919-350-7976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0096-00465
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: