Provider Demographics
NPI:1093705386
Name:KLINE, THOMAS F (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:KLINE
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6409 PERNOD WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7104
Mailing Address - Country:US
Mailing Address - Phone:919-521-8698
Mailing Address - Fax:919-869-2997
Practice Address - Street 1:6409 PERNOD WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7104
Practice Address - Country:US
Practice Address - Phone:919-521-8698
Practice Address - Fax:919-869-2997
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-00461207RG0300X
NC200800461208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911064Medicaid
NC5911064Medicaid