Provider Demographics
NPI:1164452512
Name:THOMASON, HENRY C JR (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:THOMASON
Suffix:JR
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 1:1021 X RAY DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-7489
Mailing Address - Country:US
Mailing Address - Phone:704-867-2341
Mailing Address - Fax:704-867-9019
Practice Address - Street 1:1021 X RAY DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-7489
Practice Address - Country:US
Practice Address - Phone:704-867-2341
Practice Address - Fax:704-867-9019
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15594207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCE16391Medicaid
NC110125028OtherRAILROAD MEDICARE
NC82770OtherBCBSNC PROVIDER #
NC8982770Medicaid
NCC86752Medicare UPIN
NC8982770Medicaid