Provider Demographics
NPI:1689613994
Name:THOMAS, DILIP ABRAHAM (MD)
Entity Type:Individual
Prefix:
First Name:DILIP
Middle Name:ABRAHAM
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 1:300 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 1:4 MEDICAL PARK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6807
Practice Address - Country:US
Practice Address - Phone:803-434-2020
Practice Address - Fax:803-434-1581
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047273207W00000X, 207WX0200X, 207WX0200X
SC90732207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000831707EMedicaid
SCG47273Medicaid
GA000831707FMedicaid
GA10053866OtherAMERIGROUP
GA349833OtherWELLCARE OF GA
GA18BDGNMMedicare PIN
GA349833OtherWELLCARE OF GA
GA000831707FMedicaid
GAP00342988Medicare PIN
GA0412940004Medicare NSC
GA0412940001Medicare NSC
GA000831707EMedicaid
G56089Medicare UPIN