Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | D66269 | MD |
N | 111NI0900X | Internist | D66269 | MD |
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | 40840 | SC |
N | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | D66269 | MD |
N | 207RC0000X | Internist - Cardiovascular Disease | D66269 | MD |
NPI | 1104972751 |
---|---|
Provider Name | Dr. Ryan James Tedford |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2007 |
Last Update Date | 16/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017335500 | (05) | MD |
19477 | (02) | MD |