MEDICARE: DR. DONALD J SUDY 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	207P00000X	Emergency Medicine Physician	200201009	NC
2	202K00000X	Phlebology Physician	200201009	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	7019449	OTHER		AETNA

General Provider Information

NPI Number	:	1174705396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONALD J SUDY MD

Provider Business Mailing Address
First Line	:	5821 FAIRVIEW RD STE 115
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3649
Country	:	US
Telephone Number	:	704-643-2205
Fax Number	:

Provider Business Practice Location Address
First Line	:	5821 FAIRVIEW RD STE 115
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3649
Country	:	US
Telephone Number	:	704-643-2205
Fax Number	:

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

Provider Enumeration Date	:	11/29/2007
Last Update Date	:	10/07/2024

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