Provider Demographics
NPI:1962637926
Name:THEKKEKANDAM, THOMAS JOSEPH (MD, ABFM, CAQSM)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:THEKKEKANDAM
Suffix:
Gender:M
Credentials:MD, ABFM, CAQSM
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5105
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-5100
Mailing Address - Country:US
Mailing Address - Phone:336-375-2300
Mailing Address - Fax:336-375-2314
Practice Address - Street 1:1130 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1038
Practice Address - Country:US
Practice Address - Phone:336-375-2300
Practice Address - Fax:336-375-2314
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2025-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2012-01709207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCFM2785Medicare UPIN