Provider Demographics
NPI:1710977087
Name:KIRTLEY, THOMAS LLOYD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LLOYD
Last Name:KIRTLEY
Suffix:JR
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 1:4252 ARENDELL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-0010
Mailing Address - Country:US
Mailing Address - Phone:252-222-0204
Mailing Address - Fax:252-222-0433
Practice Address - Street 1:4252 ARENDELL ST
Practice Address - Street 2:SUITE A
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-0010
Practice Address - Country:US
Practice Address - Phone:252-222-0204
Practice Address - Fax:252-222-0433
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28768207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8949549Medicaid
NC207895AMedicare PIN
NCC84941Medicare UPIN