1699351239 NPI number — THOMAS MILLER SISSON MD

Table of content: THOMAS MILLER SISSON MD (NPI 1699351239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699351239 NPI number — THOMAS MILLER SISSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SISSON
Provider First Name:
THOMAS
Provider Middle Name:
MILLER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1699351239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7506 HOSPITAL NORTH
Provider Second Line Business Mailing Address:
DUMC BOX 3090
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27710
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-681-8927
Provider Business Mailing Address Fax Number:
919-681-8927

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7506 HOSPITAL NORTH
Provider Second Line Business Practice Location Address:
DUMC BOX 3090
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-681-8927
Provider Business Practice Location Address Fax Number:
919-681-8927
Provider Enumeration Date:
03/23/2021

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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