Provider Demographics
NPI:1689606675
Name:CARPENTER, THOMAS CHARLES
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 FRANTZ RD 250
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-544-6161
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:300 NORTH AVE.
Practice Address - Street 2:
Practice Address - City:300 NORTH AVE.
Practice Address - State:MI
Practice Address - Zip Code:49016
Practice Address - Country:US
Practice Address - Phone:616-966-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA01223NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered