MEDICARE: BRADY DUMONT PA-C

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	363AS0400X	Surgical Physician Assistant
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1639012578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRADY DUMONT PA-C

Provider Business Mailing Address
First Line	:	25 COURTENAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	843-792-1952
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 COURTENAY DR
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-8911
Country	:	US
Telephone Number	:	843-792-1952
Fax Number	:

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

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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Directions to “ BRADY DUMONT PA-C” Practice Location

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