Provider Demographics
NPI:1609856988
Name:MASKELL, THOMAS H (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:MASKELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 BROOKFIELD BLVD STE 400B
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6583
Mailing Address - Country:US
Mailing Address - Phone:864-605-3738
Mailing Address - Fax:864-605-3587
Practice Address - Street 1:2310 WADE HAMPTON BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-1043
Practice Address - Country:US
Practice Address - Phone:864-292-5915
Practice Address - Fax:864-244-7734
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC12528207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC12528OtherSC LICENSE
SC6085Medicare ID - Type Unspecified
SC6475280001Medicare NSC
SCB91550Medicare UPIN
SC57-1071107OtherTIN
SCAM2837663OtherDEA NUMBER
SCB91550Medicare UPIN