Provider Demographics
NPI:1124086400
Name:PHILIP, THOMAS MANON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:MANON
Last Name:PHILIP
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 1:1325 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3860
Mailing Address - Country:US
Mailing Address - Phone:864-725-4272
Mailing Address - Fax:864-725-4452
Practice Address - Street 1:1325 SPRING ST
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-4272
Practice Address - Fax:864-725-4452
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23201208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC576007863095OtherBCBS OF SC ID
SC9931054OtherCIGNA ID
SC5741637OtherAETNA ID
SC576007863071OtherBLUECHOICE HEALTHPLAN ID
SC232019Medicaid
SC576007863095OtherBCBS OF SC ID
SC9931054OtherCIGNA ID
SCH63357Medicare UPIN
SCH633573640Medicare PIN
SC576007863071OtherBLUECHOICE HEALTHPLAN ID