Provider Demographics
NPI:1851398929
Name:SEREY, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:SEREY
Suffix:
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 1:2000 E GREENVILLE ST
Mailing Address - Street 2:SUITE 5140
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1580
Mailing Address - Country:US
Mailing Address - Phone:864-716-6100
Mailing Address - Fax:864-716-6120
Practice Address - Street 1:2000 E GREENVILLE ST
Practice Address - Street 2:SUITE 5140
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1580
Practice Address - Country:US
Practice Address - Phone:864-716-6100
Practice Address - Fax:864-716-6120
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32930208800000X
SC36493208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01472100OtherRR MEDICARE
SC364939Medicaid
KY64329303Medicaid
SCP01472100OtherRR MEDICARE
SC364939Medicaid
KYP400038745Medicare PIN
KYG50452Medicare UPIN
KY340013354Medicare PIN
KY0646903Medicare PIN
KY0383304Medicare PIN
KY0169Medicare PIN