Provider Demographics
NPI:1932169034
Name:WEST, THADDEUS C JR (MD)
Entity Type:Individual
Prefix:
First Name:THADDEUS
Middle Name:C
Last Name:WEST
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-0250
Mailing Address - Country:US
Mailing Address - Phone:800-634-0201
Mailing Address - Fax:866-727-0896
Practice Address - Street 1:2400 WAYNE MEMORIAL DRIVE
Practice Address - Street 2:SUITE I
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-739-9060
Practice Address - Fax:919-739-9099
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9600773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891087KMedicaid
NC2248868CMedicare PIN
NC891087KMedicaid
NC891087KMedicaid
NC1087KOtherBCBS