Provider Demographics
NPI:1659349744
Name:THOMAS, DAVID TIMOTHY (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:TIMOTHY
Last Name:THOMAS
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 1:660 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2104
Mailing Address - Country:US
Mailing Address - Phone:704-867-0735
Mailing Address - Fax:704-867-0738
Practice Address - Street 1:660 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE 301
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2104
Practice Address - Country:US
Practice Address - Phone:704-867-0735
Practice Address - Fax:704-867-0738
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34178207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982661Medicaid
E93871Medicare UPIN
NC8982661Medicaid