Healthcare Provider Details

I. General information

NPI: 1417976721
Provider Name (Legal Business Name): CEDREK LATROY MCFADDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CENTENNIAL WAY
GREENVILLE SC
29605-4662
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 764-522-8000
  • Fax: 864-522-8005
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number27164
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: