Provider Demographics
NPI:1164606026
Name:BEADLE, THOMAS JAMES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JAMES
Last Name:BEADLE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 40908
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0908
Mailing Address - Country:US
Mailing Address - Phone:910-615-6949
Mailing Address - Fax:910-615-9761
Practice Address - Street 1:1251 OLIVER ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4450
Practice Address - Country:US
Practice Address - Phone:910-822-6587
Practice Address - Fax:910-426-6587
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2023-06-20
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Provider Licenses
StateLicense IDTaxonomies
NC2022-01915208600000X, 2086S0129X
LAMD.200997208600000X
TXN61652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB128515Medicare PIN