Individual provider Active NPI

Cynthia Francis Pudukadan, MD

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
National Provider Identifier
1487897310
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
2015-01193 Issued in NC
Practice address
1900 Randolph Rd
Suite 1010
Charlotte, NC 28207-1122
Phone
(704) 384-1390
Fax
(704) 384-1063
NPI assigned
Apr 7, 2009
Last updated
Feb 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 2015-01193 NC Primary
Pediatrics Physician 208000000X 2015-01193 NC

Addresses

Primary practice location

1900 Randolph Rd
Suite 1010
Charlotte, NC 28207-1122

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 384-1390

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cpudukadan254751@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160119000146 NC Practitioner - Pediatric Medicine 3476856949 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
2015-01193NCMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC Neurology With Special Qualifications in Child Neurology Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Oct 1, 2015 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Oct 1, 2015 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

1900 Randolph Rd
Ste 1010
Charlotte, NC 28207
Phone (704) 334-7311

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1487897310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-1390",
            "fax_number": "704-384-1063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 RANDOLPH RD",
            "address_2": "SUITE 1010",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071122",
            "telephone_number": "704-384-1390",
            "fax_number": "704-384-1063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRANCIS PUDUKADAN",
        "first_name": "CYNTHIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-04-07",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "NC",
            "license": "2015-01193",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2015-01193",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cpudukadan254751@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1900 Randolph Rd",
            "address_2": "Suite 1010",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282071122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.