Provider Demographics
NPI:1437102720
Name:VERDIN, THOMAS M (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:M
Last Name:VERDIN
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 1:9869 OCEAN HWY W STE 12
Mailing Address - Street 2:
Mailing Address - City:CALABASH
Mailing Address - State:NC
Mailing Address - Zip Code:28467-2636
Mailing Address - Country:US
Mailing Address - Phone:910-575-3522
Mailing Address - Fax:910-575-3580
Practice Address - Street 1:9869 OCEAN HWY W STE 12
Practice Address - Street 2:
Practice Address - City:CALABASH
Practice Address - State:NC
Practice Address - Zip Code:28467-2636
Practice Address - Country:US
Practice Address - Phone:910-575-3522
Practice Address - Fax:910-575-3580
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5565208000000X
NC2009-01427208000000X
FLME 104768208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCFQC024Medicaid
421890Medicare ID - Type UnspecifiedUGS MEDICARE
SCFQC024Medicaid
B92230Medicare UPIN