Provider Demographics
NPI:1437235462
Name:LISZKA, THOMAS GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:GEORGE
Last Name:LISZKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6200 WOODLEIGH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226-8530
Mailing Address - Country:US
Mailing Address - Phone:704-544-9092
Mailing Address - Fax:704-844-9420
Practice Address - Street 1:1635 MATTHEWS TOWNSHIP PARKWAY
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105
Practice Address - Country:US
Practice Address - Phone:704-844-8344
Practice Address - Fax:704-844-9420
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9600986208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF58060Medicare UPIN