Provider Demographics
NPI:1932115342
Name:PRICE, THOMAS W IV (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:PRICE
Suffix:IV
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9499
Mailing Address - Country:US
Mailing Address - Phone:336-763-9355
Mailing Address - Fax:336-768-3078
Practice Address - Street 1:3911 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410
Practice Address - Country:US
Practice Address - Phone:336-763-9355
Practice Address - Fax:336-768-3078
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6866183500000X
NC268213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890808CMedicaid
NC890808CMedicaid
NC243164EMedicare PIN