Provider Demographics
NPI:1366794109
Name:MCCUTCHEN, THOMAS MCCONNELL JR (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MCCONNELL
Last Name:MCCUTCHEN
Suffix:JR
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 1:3217 BRECHIN RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4905
Mailing Address - Country:US
Mailing Address - Phone:910-303-2091
Mailing Address - Fax:
Practice Address - Street 1:413 OWEN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3489
Practice Address - Country:US
Practice Address - Phone:910-303-2091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15774174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist