Provider Demographics
NPI:1114996725
Name:STOUT, THOMAS FRANKLIN I (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:FRANKLIN
Last Name:STOUT
Suffix:I
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 1:1010 EDGEHILL RD N
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1885
Practice Address - Country:US
Practice Address - Phone:704-446-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2023-12-18
Deactivation Date:2012-03-23
Deactivation Code:
Reactivation Date:2017-01-10
Provider Licenses
StateLicense IDTaxonomies
NC2016-011702084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1114996725Medicaid
SC168464Medicaid
SCG31198Medicare UPIN
SC168464Medicaid
SC3124Medicare PIN