Provider Demographics
NPI:1336184118
Name:DASHIELL, THOMAS JR (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DASHIELL
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 1:3601 SW 160TH AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-6314
Mailing Address - Country:US
Mailing Address - Phone:954-399-4673
Mailing Address - Fax:
Practice Address - Street 1:140 TOKEENA RD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1744
Practice Address - Country:US
Practice Address - Phone:954-399-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12702208M00000X
NC2005-01259208M00000X
SCMD12702207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2052656OtherCIGNA GOV. SERVICES NC
SCGP4059Medicaid
SC127026Medicaid
SC12702OtherMEDICAL LICENSE
NC1336184118Medicaid
NC200501259OtherMEDICAL LICENSE
NC2052656OtherCIGNA GOV. SERVICES NC
NC1336184118Medicaid
SCGP4059Medicaid
SC12702OtherMEDICAL LICENSE
NC200501259OtherMEDICAL LICENSE
NCNCK610BMedicare PIN