Provider Demographics
NPI:1417095522
Name:KITCHENS, THOMAS RUSSELL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:KITCHENS
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 1:1507 WESTOVER TER
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7130
Mailing Address - Country:US
Mailing Address - Phone:336-373-0566
Mailing Address - Fax:336-373-0667
Practice Address - Street 1:1507 WESTOVER TER
Practice Address - Street 2:SUITE A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7130
Practice Address - Country:US
Practice Address - Phone:336-373-0566
Practice Address - Fax:336-373-0667
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21284208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Not Answered2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCC85384Medicare UPIN