Provider Demographics
NPI:1093877326
Name:WHITFIELD, THOMAS P (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:WHITFIELD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4444 PARK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-3130
Mailing Address - Country:US
Mailing Address - Phone:704-716-3338
Mailing Address - Fax:704-522-6588
Practice Address - Street 1:4444 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3130
Practice Address - Country:US
Practice Address - Phone:704-716-3338
Practice Address - Fax:704-522-6588
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC231213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6220020001Medicare NSC
T64080Medicare UPIN