Provider Demographics
NPI:1518997907
Name:THOMA, MATTHEW N (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:N
Last Name:THOMA
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 1:131 SUMMERPLACE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3058
Mailing Address - Country:US
Mailing Address - Phone:803-608-2511
Mailing Address - Fax:803-796-8924
Practice Address - Street 1:131 SUMMERPLACE DR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3058
Practice Address - Country:US
Practice Address - Phone:803-608-2511
Practice Address - Fax:803-796-8924
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00124207R00000X
SC36132207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC142R6OtherBCBS OF NC
NC2054883Medicare ID - Type Unspecified
NC142R6OtherBCBS OF NC