Provider Demographics
NPI:1881667830
Name:KING, THOMAS C (MD, PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:KING
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 BAYVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4068
Mailing Address - Country:US
Mailing Address - Phone:401-398-1173
Mailing Address - Fax:
Practice Address - Street 1:218 BAYVIEW AVE
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4068
Practice Address - Country:US
Practice Address - Phone:401-398-1173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219300207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30204451Medicaid
MA2024951Medicaid
MAA36119Medicare ID - Type Unspecified
NH30204451Medicaid