Provider Demographics
NPI:1104858570
Name:SENA, THOMAS JOHN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:SENA
Suffix:
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 1:3100 DURALEIGH RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-8106
Mailing Address - Country:US
Mailing Address - Phone:919-781-7490
Mailing Address - Fax:
Practice Address - Street 1:3100 DURALEIGH RD
Practice Address - Street 2:SUITE 300
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8106
Practice Address - Country:US
Practice Address - Phone:919-781-7490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
75208OtherBCBS
NC8975208Medicaid
75208OtherBCBS