Provider Demographics
NPI:1568446581
Name:BELLER, THOMAS CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:BELLER
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 1:60 MAIN STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29926-6603
Mailing Address - Country:US
Mailing Address - Phone:843-689-6442
Mailing Address - Fax:843-689-6158
Practice Address - Street 1:300 NEW RIVER PARKWAY
Practice Address - Street 2:BLDG 6 SUITE 11
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4453
Practice Address - Country:US
Practice Address - Phone:843-208-6442
Practice Address - Fax:843-208-3401
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26810207KI0005X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4321Medicaid
SCGP43210Medicaid
SCH652868083Medicare UPIN
SC8420Medicare PIN
SCGP43210Medicaid