Provider Demographics
NPI:1396782512
Name:QUIRKE, THOMAS E (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:E
Last Name:QUIRKE
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 1:3769 SEA MOUNTAIN HWY
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-7861
Mailing Address - Country:US
Mailing Address - Phone:843-467-5972
Mailing Address - Fax:843-507-8732
Practice Address - Street 1:3769 SEA MOUNTAIN HWY
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-7861
Practice Address - Country:US
Practice Address - Phone:843-467-5972
Practice Address - Fax:843-507-8732
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21736208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT58292Medicaid
SCG528655327Medicare PIN
SCG52865Medicare UPIN
SCG528655216Medicare PIN
SCG528658931Medicare PIN