Provider Demographics
NPI:1063408300
Name:EDWARDS, BRYAN TODD (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:TODD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-1830
Mailing Address - Fax:704-316-1835
Practice Address - Street 1:19485 OLD JETTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6582
Practice Address - Country:US
Practice Address - Phone:704-316-1830
Practice Address - Fax:704-316-1835
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00386207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907841Medicaid
NC2070999AMedicare PIN