MEDICARE: DR. BRIAN G RALPH DPM

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	213ES0131X	Foot Surgery Podiatrist	537	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00834839	OTHER	SC	RAILROAD MEDICARE ID-RSFPN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154306181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN G RALPH DPM

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	2270 ASHLEY CROSSING DR STE 110
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5749
Country	:	US
Telephone Number	:	843-853-3474
Fax Number	:	843-853-3500

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

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	12/23/2021

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