Provider Demographics
NPI:1083875058
Name:THERUVATH, TOM PRAKASH (MD)
Entity type:Individual
Prefix:DR
First Name:TOM
Middle Name:PRAKASH
Last Name:THERUVATH
Suffix:
Gender:M
Credentials:MD
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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:704-316-5100
Mailing Address - Fax:704-316-5101
Practice Address - Street 1:301 HAWTHORNE LANE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2467
Practice Address - Country:US
Practice Address - Phone:704-316-5100
Practice Address - Fax:704-316-5101
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2020-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL 30838208600000X
NC2015-01140208600000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery