Provider Demographics
NPI:1215907993
Name:GROTE, THOMAS H (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:GROTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 60516
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0516
Mailing Address - Country:US
Mailing Address - Phone:336-903-6362
Mailing Address - Fax:336-903-6354
Practice Address - Street 1:1913 W PARK DR
Practice Address - Street 2:
Practice Address - City:N WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659-3564
Practice Address - Country:US
Practice Address - Phone:336-903-6362
Practice Address - Fax:336-903-6354
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC31138207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215907993Medicaid
NC336OtherPARTNERS NATIONAL HEALTH
P00031316OtherRAILROAD MEDICARE
3603475OtherUNITED HEALTH CARE
VA006005586Medicaid
24690OtherMEDCOST
4098738OtherAETNA PPO
3097025OtherAETNA HMO
NC8937807Medicaid
NC37807OtherBLUE CROSS AND BLUE SHIEL
C84204Medicare UPIN
206583DMedicare PIN
VA006005586Medicaid