Provider Demographics
NPI:1780653816
Name:ANDRUS, THOMAS ROSS JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ROSS
Last Name:ANDRUS
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 1:3809 COMPUTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-6518
Mailing Address - Country:US
Mailing Address - Phone:919-782-3782
Mailing Address - Fax:
Practice Address - Street 1:3809 COMPUTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6518
Practice Address - Country:US
Practice Address - Phone:919-782-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26079207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4641217-003OtherCIGNA
NC11518OtherNC BLUECROSS BLUESHIELD
NC0350477OtherUNITED HEALTHCARE
NC8911518Medicaid
202781AMedicare ID - Type Unspecified
NC4641217-003OtherCIGNA