Provider Demographics
NPI:1144225087
Name:MADDOX, THOMAS WILBUR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILBUR
Last Name:MADDOX
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 1:2800 BLUE RIDGE RD
Mailing Address - Street 2:STE 503
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6477
Mailing Address - Country:US
Mailing Address - Phone:919-782-8210
Mailing Address - Fax:919-781-4650
Practice Address - Street 1:2800 BLUE RIDGE RD
Practice Address - Street 2:STE 503
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6477
Practice Address - Country:US
Practice Address - Phone:919-782-8210
Practice Address - Fax:919-781-4650
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29326208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC53706OtherBCBS-NC
NC8953706Medicaid
NC53706OtherBCBS-NC
NC208431BMedicare PIN
NC208431AMedicare PIN