Provider Demographics
NPI:1619031614
Name:BRACKBILL, THOMAS ANDREW (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANDREW
Last Name:BRACKBILL
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 1:1200 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1004
Mailing Address - Country:US
Mailing Address - Phone:336-832-7000
Mailing Address - Fax:336-851-8427
Practice Address - Street 1:1002 N CHURCH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1439
Practice Address - Country:US
Practice Address - Phone:336-272-6133
Practice Address - Fax:336-271-9043
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19909207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
561240263OtherCOMMERCIAL
NC8915976Medicaid
435OtherPARTNERS
060041999OtherRR MEDICARE
435OtherPARTNERS MEDICARE
NC15976OtherBCBS
060041999OtherRR MEDICARE
C82925Medicare UPIN