Provider Demographics
NPI:1740232016
Name:THOMAS, KAREN W (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:F
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:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:180 WINGO WAY
Practice Address - Street 2:SUITE 306
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1810
Practice Address - Country:US
Practice Address - Phone:843-884-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC18645207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC186453Medicaid
SCP00775524OtherRAILROAD MEDICARE ID-EFFECTIVE 5/11/2009
SC110232040OtherRR MEDICARE
SCG665416795Medicare PIN
SCG665414959Medicare PIN
SC110165797Medicare ID - Type UnspecifiedRR
SCP00775524OtherRAILROAD MEDICARE ID-EFFECTIVE 5/11/2009
SCG66541Medicare UPIN