Provider Demographics
NPI:1770611782
Name:THOMAS J. CARZOLI, M.D., P.A.
Entity type:Organization
Organization Name:THOMAS J. CARZOLI, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CARZOLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-765-2090
Mailing Address - Street 1:1301 TAYLOR STREET
Mailing Address - Street 2:SUITE 5K
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2950
Mailing Address - Country:US
Mailing Address - Phone:803-765-2090
Mailing Address - Fax:803-765-0580
Practice Address - Street 1:1301 TAYLOR STREET
Practice Address - Street 2:SUITE 5K
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2950
Practice Address - Country:US
Practice Address - Phone:803-765-2090
Practice Address - Fax:803-765-0580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC090074Medicaid
SCB914230281Medicare ID - Type Unspecified
SC090074Medicaid