Provider Demographics
NPI:1679563852
Name:DYAR, THOMAS ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT
Last Name:DYAR
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 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:1351 CRESTVIEW RD
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-2408
Practice Address - Country:US
Practice Address - Phone:864-855-5006
Practice Address - Fax:864-850-0240
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047311207V00000X
SC19496207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC194961Medicaid
GA003175707BMedicaid
GA003175707AMedicaid