Provider Demographics
NPI:1265472773
Name:THORNTON, DAVID C (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:THORNTON
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 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8798
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:
Practice Address - Street 1:205 PAGE RD
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8798
Practice Address - Country:US
Practice Address - Phone:910-295-5511
Practice Address - Fax:910-235-3401
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002-00815207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4800398OtherEVERCARE
NC89131TTMedicaid
NCB7696OtherMEDCOST PROVIDER#
NCFH2001080OtherFCC PROVIDER#
SCN00815OtherSC MEDICAID PROVIDER#
NY060069078OtherPALMETTO GBA #
NC131TTOtherBC/BS PROVIDER#
NC2006271Medicare ID - Type Unspecified
NC89131TTMedicaid