Provider Demographics
NPI:1376589374
Name:THORP, ADAM TREDWELL IV (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:TREDWELL
Last Name:THORP
Suffix:IV
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 1:120 WILLIAM PENN PLZ
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2150
Mailing Address - Country:US
Mailing Address - Phone:919-281-1836
Mailing Address - Fax:919-313-1276
Practice Address - Street 1:1803 FOREST HILLS ROAD
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3412
Practice Address - Country:US
Practice Address - Phone:252-243-9629
Practice Address - Fax:252-399-6261
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600343207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCC358AMedicare PIN