Provider Demographics
NPI:1740280841
Name:KAELIN, THOMAS D JR (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:KAELIN
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 MEDCOM ST. STE B
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:843-871-4006
Mailing Address - Fax:843-871-4074
Practice Address - Street 1:9150 MEDCOM ST. STE B
Practice Address - Street 2:
Practice Address - City:N CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406
Practice Address - Country:US
Practice Address - Phone:843-871-4006
Practice Address - Fax:843-871-4074
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC495207RC0200X, 207RS0012X
SC0495207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC004952Medicaid
SC004952Medicaid
F97999Medicare UPIN
SCF979998041Medicare ID - Type Unspecified