Provider Demographics
NPI:1588618334
Name:MCFADDEN, THOMAS CORNELIUS JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CORNELIUS
Last Name:MCFADDEN
Suffix:JR
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 1:29 ROCKY SLOPE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3909
Mailing Address - Country:US
Mailing Address - Phone:864-297-9113
Mailing Address - Fax:864-297-9184
Practice Address - Street 1:29 ROCKY SLOPE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3909
Practice Address - Country:US
Practice Address - Phone:864-297-9113
Practice Address - Fax:864-297-9184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22366174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC223662Medicaid
SC223662Medicaid