Provider Demographics
NPI:1326096348
Name:OLIVER, THOMAS LANIER (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:LANIER
Last Name:OLIVER
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8303
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DRIVE
Practice Address - Street 2:SUITE C300
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3557
Practice Address - Country:US
Practice Address - Phone:864-454-8272
Practice Address - Fax:864-454-2875
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00115378OtherRR MEDICARE
SC4399257OtherAETNA ID
SC576007863071OtherBCBS OF SC
SC109741Medicaid
SC4399257OtherAETNA ID
SCB92139Medicare UPIN
SCB921397951Medicare PIN