Provider Demographics
NPI:1114939972
Name:THOMAS, SUSAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:F
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 CHAPIN ROAD
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036
Mailing Address - Country:US
Mailing Address - Phone:803-345-3414
Mailing Address - Fax:803-345-1672
Practice Address - Street 1:1612 CHAPIN ROAD
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036
Practice Address - Country:US
Practice Address - Phone:803-345-3414
Practice Address - Fax:803-345-1672
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12052207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC120522Medicaid
D90733Medicare PIN