Provider Demographics
NPI:1912955774
Name:HEARON, THOMAS E (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:HEARON
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 1:2601 LAUREL ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2033
Mailing Address - Country:US
Mailing Address - Phone:803-744-4900
Mailing Address - Fax:803-744-4935
Practice Address - Street 1:2601 LAUREL ST
Practice Address - Street 2:SUITE 260
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2033
Practice Address - Country:US
Practice Address - Phone:803-744-4900
Practice Address - Fax:803-744-4935
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC05697207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC56977Medicaid
SCD99250Medicare UPIN