MEDICARE: SCOTT H BRUNDLE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	2000-01079	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265P	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144274119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT H BRUNDLE MD

Provider Business Mailing Address
First Line	:	4505 FAIR MEADOWS LN STE 101
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27607-6449
Country	:	US
Telephone Number	:	919-783-9600
Fax Number	:	919-783-9675

Provider Business Practice Location Address
First Line	:	4505 FAIR MEADOWS LN
Second Line	:	STE 101
City	:	RALEIGH
State	:	NC
Zip	:	27607-6465
Country	:	US
Telephone Number	:	919-783-9600
Fax Number	:	919-783-9675

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	01/30/2026

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Directions to “ SCOTT H BRUNDLE MD” Practice Location

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