Provider Demographics
NPI:1487637989
Name:MARCOTTE, THOMAS PAUL (CRNA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PAUL
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT
Mailing Address - Street 2:SUITE 212
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4545
Mailing Address - Country:US
Mailing Address - Phone:864-797-6400
Mailing Address - Fax:
Practice Address - Street 1:298 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29672-9443
Practice Address - Country:US
Practice Address - Phone:864-882-3351
Practice Address - Fax:864-885-7619
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN2122367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN1413Medicaid
SCQ33923E307Medicare PIN
SCQ33923Medicare ID - Type Unspecified
SCAN1413Medicaid
SCGP2991Medicaid
SC6877Medicare ID - Type UnspecifiedGROUP