Provider Demographics
NPI:1285628842
Name:PHILBRICK, THOMAS HERBERT (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HERBERT
Last Name:PHILBRICK
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 1:7505 WATERS AVE
Mailing Address - Street 2:SUITE C8
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3825
Mailing Address - Country:US
Mailing Address - Phone:912-352-2606
Mailing Address - Fax:912-352-0623
Practice Address - Street 1:7505 WATERS AVE
Practice Address - Street 2:SUITE C8
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3825
Practice Address - Country:US
Practice Address - Phone:912-352-2606
Practice Address - Fax:912-352-0623
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0234922085B0100X, 2085N0700X, 2085N0904X, 2085P0229X, 2085R0202X, 2085R0203X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00252634AMedicaid
SCG23492Medicaid
GA023576OtherBLUE CROSS
GA010578OtherBCBS GA
GA000252634DMedicaid
GA023576OtherBLUE CROSS
GAD21820Medicare UPIN
SCG23492Medicaid
GA30BDNCGMedicare PIN
GA30CDBHXMedicare ID - Type UnspecifiedMEDICARE