1508839424 NPI number — THOMAS J D'ORAZIO M.D., PH.D.

Table of content: THOMAS J D'ORAZIO M.D., PH.D. (NPI 1508839424)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508839424 NPI number — THOMAS J D'ORAZIO M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
D'ORAZIO
Provider First Name:
THOMAS
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508839424
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8210 DEVON CT # B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MYRTLE BEACH
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29572-4178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-839-5328
Provider Business Mailing Address Fax Number:
843-839-5289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8210 DEVON CT # B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MYRTLE BEACH
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29572-4178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-839-5328
Provider Business Practice Location Address Fax Number:
843-839-5289
Provider Enumeration Date:
02/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  MD83485 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: MD425755 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1080473 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1738873 . This is a "HIGHMARK BC/BS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3331130 . This is a "CIGNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 834850 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7230715 . This is a "AETNA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 1012981580001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410684 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 150888839424 . This is a "HUMANA" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com