Provider Demographics
NPI:1710973516
Name:THORE, TAMMY L (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:L
Last Name:THORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28640-9244
Mailing Address - Country:US
Mailing Address - Phone:336-246-7779
Mailing Address - Fax:336-846-8370
Practice Address - Street 1:525 LUTHER RD
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28640
Practice Address - Country:US
Practice Address - Phone:336-846-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35534208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7983237Medicaid
NC43058OtherMEDCOST
NC83237OtherBCBS NC
NC11982OtherPARTNERS
VA010345359Medicaid
NC770000140OtherRAILROAD MEDICARE
NC891046LMedicaid
NC5277206002OtherCIGNA HEALTHCARE
NC7983237Medicaid