Provider Demographics
NPI:1336213883
Name:DOUGLAS, THOMAS H (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:DOUGLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9735 KINCEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-9118
Mailing Address - Country:US
Mailing Address - Phone:704-414-2870
Mailing Address - Fax:704-414-2860
Practice Address - Street 1:1780 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1194
Practice Address - Country:US
Practice Address - Phone:803-327-1116
Practice Address - Fax:803-327-6872
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC99-00476208800000X
VA0101045853208800000X
SC21281208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912374Medicaid
SC0007034011OtherAETNA
NC136HXOtherBCBS OF NC
SC212816Medicaid
SC1905793OtherUNITED HEALTHCARE
SC867215OtherGREAT WEST
SC90023OtherMEDCOST
SC279873OtherMAMSI
SCG981816566Medicare PIN
SC90023OtherMEDCOST
SC340018264Medicare PIN
SC867215OtherGREAT WEST
SC279873OtherMAMSI