Provider Demographics
NPI:1134137912
Name:STUBBS, THOMAS M (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:STUBBS
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 1:2 MEDICAL PARK ROAD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6839
Mailing Address - Country:US
Mailing Address - Phone:803-545-5700
Mailing Address - Fax:803-434-4699
Practice Address - Street 1:2 MEDICAL PARK ROAD SUITE 106
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6839
Practice Address - Country:US
Practice Address - Phone:803-545-5700
Practice Address - Fax:803-434-4699
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC39490207VM0101X
NC000039490207V00000X
SC11316207VM0101X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1134137912Medicaid
SC113166Medicaid
NC80695OtherBCBS NC
NC7980695Medicaid
NC160048301Medicare PIN
NC7980695Medicaid
NC80695OtherBCBS NC
NC2159171CMedicare PIN
NCNCH224AMedicare PIN