Provider Demographics
NPI:1407825318
Name:LARGE, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:LARGE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-213-1994
Mailing Address - Fax:828-213-1992
Practice Address - Street 1:21 HOSPITAL DR
Practice Address - Street 2:SUITE 4200
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4550
Practice Address - Country:US
Practice Address - Phone:828-213-1994
Practice Address - Fax:828-213-1992
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA104417207X00000X
NC200301252207X00000X
GA88530207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery