Provider Demographics
NPI:1679653232
Name:KINGSLEY, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KINGSLEY
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 1:200 E NORTHWOOD ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 E NORTHWOOD ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1224
Practice Address - Country:US
Practice Address - Phone:336-832-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2012-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701438207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC24576OtherPARTNERS MEDICARE
NC80996OtherMEDCOST
NC891169XMedicaid
NC1169XOtherBCBS OF NC
NC80996OtherMEDCOST
NC080130962Medicare PIN
NC2254157Medicare PIN