Individual
DR. TRACY LEIGH CORDRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2093 HENRY TECKLENBURG DR STE 340, CHARLESTON, SC 29414-5741
(843) 718-2334
(843) 277-2067
Mailing address
2093 HENRY TECKLENBURG DR STE 340, CHARLESTON, SC 29414-5741
(843) 718-2334
(843) 277-2067
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
A79618
CA
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
22185
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1346432614
INDIVIDUAL NPI
SC
05
—
30236309
—
SC
01
—
813653106
TAX ID
SC
01
—
SC5037G677
MEDICARE PTAN
SC
Enumeration date
08/10/2007
Last updated
10/13/2022
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