Provider Demographics
NPI:1568500668
Name:SPEROS, THOMAS L (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:L
Last Name:SPEROS
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:PO BOX 890194
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-0194
Mailing Address - Country:US
Mailing Address - Phone:910-795-1471
Mailing Address - Fax:
Practice Address - Street 1:1121 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 377
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3968
Practice Address - Country:US
Practice Address - Phone:910-795-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20967207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8978870Medicaid
NC8978870Medicaid
NCE39849Medicare UPIN