Provider Demographics
NPI:1104966951
Name:PALUCH, THOMAS J (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:PALUCH
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SAINT ANDREW ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-3842
Mailing Address - Country:US
Mailing Address - Phone:252-823-8944
Mailing Address - Fax:
Practice Address - Street 1:111 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TARBORO
Practice Address - State:NC
Practice Address - Zip Code:27886-2011
Practice Address - Country:US
Practice Address - Phone:252-641-7170
Practice Address - Fax:252-641-7373
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC078681163W00000X
NC034405367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse