Provider Demographics
NPI:1760433817
Name:WARCUP, THOMAS KENNETH (DO)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:KENNETH
Last Name:WARCUP
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 VILLAGE WALK DR
Mailing Address - Street 2:SUITE C140
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-7681
Mailing Address - Country:US
Mailing Address - Phone:919-552-8911
Mailing Address - Fax:
Practice Address - Street 1:208 VILLAGE WALK DR
Practice Address - Street 2:SUITE C140
Practice Address - City:HOLLY SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:27540-7681
Practice Address - Country:US
Practice Address - Phone:919-552-8911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDO 00533207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7009038Medicaid
NCNC1165AMedicare PIN
H27167Medicare UPIN
RI7009038Medicaid