Provider Demographics
NPI:1407856461
Name:RADUT, TOMA (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMA
Middle Name:
Last Name:RADUT
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:P.O. BOX 70
Mailing Address - Street 2:
Mailing Address - City:LINCOLNTON
Mailing Address - State:NC
Mailing Address - Zip Code:28093
Mailing Address - Country:US
Mailing Address - Phone:704-736-9188
Mailing Address - Fax:704-736-9667
Practice Address - Street 1:607 S. GENERALS BLVX
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-2717
Practice Address - Country:US
Practice Address - Phone:704-736-9188
Practice Address - Fax:704-736-9667
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700719207R00000X
MI4301063557207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C3175OtherMEDCOST
1066YOtherBLUE CROSS
MB08OtherPRIMARY PHYSICIAN CARE
NC891066YMedicaid
1102477226OtherRAILROAD MEDICARE
G49839Medicare UPIN
1102477226OtherRAILROAD MEDICARE
C3175OtherMEDCOST