Provider Demographics
NPI:1528027679
Name:CARZOLI, THOMAS JAMES (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:CARZOLI
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 1:1301 TAYLOR ST
Mailing Address - Street 2:SUITE 5K
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2950
Mailing Address - Country:US
Mailing Address - Phone:803-765-2090
Mailing Address - Fax:803-765-0580
Practice Address - Street 1:1301 TAYLOR ST
Practice Address - Street 2:SUITE 5K
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2950
Practice Address - Country:US
Practice Address - Phone:803-765-2090
Practice Address - Fax:803-765-0580
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9007207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC090074Medicaid
SC$$$$$$$$$OtherSSN
B91423Medicare UPIN