Provider Demographics
NPI:1750351508
Name:THOMAS, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:THOMAS
Other - Middle Name:L
Other - Last Name:ROBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 RUBY ST
Mailing Address - Street 2:
Mailing Address - City:WALTERBORO
Mailing Address - State:SC
Mailing Address - Zip Code:29488-2758
Mailing Address - Country:US
Mailing Address - Phone:843-549-5599
Mailing Address - Fax:843-549-5512
Practice Address - Street 1:300 RUBY ST
Practice Address - Street 2:
Practice Address - City:WALTERBORO
Practice Address - State:SC
Practice Address - Zip Code:29488-2758
Practice Address - Country:US
Practice Address - Phone:843-549-5599
Practice Address - Fax:843-549-5512
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17150207RC0200X, 207RP1001X, 207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1737Medicaid
SCF852628096Medicare UPIN
SCGP1737Medicaid