Provider Demographics
NPI:1447200738
Name:THOMAS, CHARLES CARROLL II (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CARROLL
Last Name:THOMAS
Suffix:II
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 1:21 E FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2909
Mailing Address - Country:US
Mailing Address - Phone:828-274-8238
Mailing Address - Fax:828-274-5157
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 10
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8046
Practice Address - Country:US
Practice Address - Phone:828-452-2320
Practice Address - Fax:828-456-4707
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0000169592085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891162CMedicaid
204140MMedicare ID - Type Unspecified
C82331Medicare UPIN