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General NPI Number Information
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NPI Number | 1871588251
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Entity Type | Individual
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Provider Name | STEPHEN T BRADY MD, FACCP, FSCAI
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Gender | Male
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Dates
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Enumeration Date | 09/13/2005
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 2376 CYPRESS CIR STE 102
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City | CONWAY
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State | SC
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Zip | 29526-8964
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Country | US
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Telephone | 843-347-8953
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Fax | 843-347-0226
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Provider Business Mailing Address
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Address Line | 300 SINGLETON RIDGE RD ATTENTION PATIENT ACCOUNTING
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City | CONWAY
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State | SC
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Zip | 29526-6119
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Country | US
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Telephone | 843-234-6946
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Fax | 843-234-8958
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 36435
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 162690
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 162690
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 36435
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License Number State | SC
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