Provider Demographics
NPI:1265474209
Name:THOMAS, KOITHARA VARKEY (MD)
Entity Type:Individual
Prefix:DR
First Name:KOITHARA VARKEY
Middle Name:
Last Name:THOMAS
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 1:277 MEMORIAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-6333
Mailing Address - Country:US
Mailing Address - Phone:910-343-9800
Mailing Address - Fax:910-343-8650
Practice Address - Street 1:EASTERN NEPHROLOGY ASSOCIATES
Practice Address - Street 2:277 MEMORIAL DRIVE
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-6333
Practice Address - Country:US
Practice Address - Phone:910-346-2263
Practice Address - Fax:910-353-0549
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300295207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1587680OtherUNITED HEALTH CARE
NC89134WEMedicaid
NC134WEOtherBC/BS-NC INDIVIDUAL #
NC134WEOtherBC/BS-NC INDIVIDUAL #
NCG34117Medicare UPIN
NC2018546Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #