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1306926548

NPI Code Detail

MEDICARE: DR. THERESA H CUDA MD

MEDICARE: DR. THERESA H CUDA 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	207LC0200X	Critical Care Medicine (Anesthesiology) Physician	15601	SC
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	15601	SC
3	207L00000X	Anesthesiology Physician	15601	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	050028874	OTHER	SC	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	77839	OTHER	SC	MEDCOST
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2001248	OTHER	SC	CCP
4	156011	OTHER	SC	SELECT HEALTH
5	4229855	OTHER	SC	AETNA

General Provider Information

NPI Number	:	1306926548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA H CUDA MD

Provider Business Mailing Address
First Line	:	300 E MCBEE AVE FL 4
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29601-2842
Country	:	US
Telephone Number	:	864-522-8614
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 TAYLOR ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-2915
Country	:	US
Telephone Number	:	803-296-5137
Fax Number	:	803-296-5499

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	02/11/2021

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Directions to “ DR. THERESA H CUDA MD” Practice Location

Language	Start Address	Practice Location

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