Provider Demographics
NPI:1154378495
Name:THORNEYCROFT, IAN H (MD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:H
Last Name:THORNEYCROFT
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 1:21 HILLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2311
Mailing Address - Country:US
Mailing Address - Phone:516-484-3222
Mailing Address - Fax:
Practice Address - Street 1:21 HILLWOOD RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2311
Practice Address - Country:US
Practice Address - Phone:516-484-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15135207VG0400X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALB65797Medicare UPIN
AL051513749Medicare ID - Type Unspecified