Provider Demographics
NPI:1104857937
Name:DUGGAN, THOMAS MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:DUGGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:500 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3634
Practice Address - Country:US
Practice Address - Phone:910-642-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01073208M00000X, 207R00000X, 208M00000X
SC35079208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1104857937Medicaid
MD699837201Medicaid
DE0001155101Medicaid
DE1104857937OtherDIAMOND STATE MEDICAID
DE438963OtherCOVENTRY HEALTH CARE
DE1104857937Medicaid
DE522011HOSOtherBCBS OF DELAWARE
DE000000207289OtherUNISON HEALTH CARE-MCAID
SC350792Medicaid
DE1104857937OtherDE PHYSICIAN CARE-MCAID
DE000000207289OtherUNISON HEALTH CARE-MCAID
DE019776B86Medicare PIN
DE0001155101Medicaid
MD699837201Medicaid
NCNC5417CMedicare PIN