Provider Demographics
NPI:1912967712
Name:THOMASON, ROBERT BRADLEY III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BRADLEY
Last Name:THOMASON
Suffix:III
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:336-794-8624
Mailing Address - Fax:336-231-8845
Practice Address - Street 1:2827 LYNDHURST AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4145
Practice Address - Country:US
Practice Address - Phone:336-794-8624
Practice Address - Fax:336-231-8845
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29966208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8982803Medicaid
NC29966OtherNC LICENSE
VA1912967712Medicaid
NCBT0354592OtherDEA NUMBER
NC29966OtherNC LICENSE
NC210937DMedicare UPIN