Healthcare Provider Details

I. General information

NPI: 1871588251
Provider Name (Legal Business Name): STEPHEN T BRADY MD, FACCP, FSCAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 07/09/2020
Certification Date: 07/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2376 CYPRESS CIR STE 102
CONWAY SC
29526-8964
US

IV. Provider business mailing address

300 SINGLETON RIDGE RD ATTENTION PATIENT ACCOUNTING
CONWAY SC
29526-6119
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-8953
  • Fax: 843-347-0226
Mailing address:
  • Phone: 843-234-6946
  • Fax: 843-234-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number36435
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number162690
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number162690
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number36435
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: