Provider Demographics
NPI:1144250663
Name:CAUDILL, FRED WELDEN (MD)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:WELDEN
Last Name:CAUDILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:130 MATTHEWS STATION ST
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-6719
Mailing Address - Country:US
Mailing Address - Phone:704-846-2833
Mailing Address - Fax:704-846-1992
Practice Address - Street 1:130 MATTHEWS STATION ST
Practice Address - Street 2:SUITE 2-B
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-6719
Practice Address - Country:US
Practice Address - Phone:704-846-2833
Practice Address - Fax:704-846-1992
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC338002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
2277165Medicare ID - Type Unspecified
E34414Medicare UPIN