Provider Demographics
NPI:1326019316
Name:MONTAGNE, THOMAS MARCEL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARCEL
Last Name:MONTAGNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:SUITE 620
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-560-1674
Practice Address - Fax:864-560-1690
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2021-02-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC12313207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4235491OtherAETNA
NC5901496Medicaid
SCT53554Medicaid
SCF228175206OtherMEDICARE PIN
SC88768OtherMEDCOST
NC5901496Medicaid
SCF22817Medicare UPIN