Provider Demographics
NPI:1720047194
Name:THOMAS-MONTILUS, SANDHYA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDHYA
Middle Name:
Last Name:THOMAS-MONTILUS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2706
Mailing Address - Country:US
Mailing Address - Phone:910-738-2330
Mailing Address - Fax:910-738-1403
Practice Address - Street 1:4320 FAYETTEVILLE RD
Practice Address - Street 2:SUITE A
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2706
Practice Address - Country:US
Practice Address - Phone:910-738-2330
Practice Address - Fax:910-738-1403
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9701618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-0226CMedicaid
2244541OtherMEDICARE PTAN INDIVIDUAL
NCG59241Medicare UPIN