Provider Demographics
NPI:1992813265
Name:PARDIECK, DAVID ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:PARDIECK
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 1:9229 UNIVERSITY BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9150
Mailing Address - Country:US
Mailing Address - Phone:843-572-4376
Mailing Address - Fax:843-572-9285
Practice Address - Street 1:9229 UNIVERSITY BLVD STE D
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9150
Practice Address - Country:US
Practice Address - Phone:843-572-4376
Practice Address - Fax:843-572-9285
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6422208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC064227Medicaid
8924350281Medicare ID - Type Unspecified
B92435Medicare UPIN