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General NPI Number Information
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NPI Number | 1225577265
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Entity Type | Organization
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Legal Business Name | CORDRAY PLASTIC SURGERY LLC
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 08/28/2025
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Provider Practice Location Address
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Address Line | 2093 HENRY TECKLENBURG DR STE 304
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City | CHARLESTON
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State | SC
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Zip | 29414-5743
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Country | US
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Telephone | 843-718-2334
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Fax | 843-277-2067
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Provider Business Mailing Address
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Address Line | 44 FOLLY ROAD BLVD STE C
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City | CHARLESTON
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State | SC
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Zip | 29407-7559
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Country | US
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Telephone | 843-718-2334
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Fax | 843-277-2067
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. TRACY L CORDRAY
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Credential | M.D.
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Telephone | 843-718-2334
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 22185
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License Number State | SC
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