Provider Demographics
NPI:1699883124
Name:BRAZA, THOMAS J (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:J
Last Name:BRAZA
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 1:144 POOLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-9504
Mailing Address - Country:US
Mailing Address - Phone:910-640-0899
Mailing Address - Fax:910-256-6039
Practice Address - Street 1:144 POOLE RD STE 101
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-9504
Practice Address - Country:US
Practice Address - Phone:910-640-0899
Practice Address - Fax:910-256-6039
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046046207ND0101X
NC2012-00516207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11182034OtherCAQH
GA000212917AMedicaid
H67814Medicare UPIN
07BBSMXMedicare ID - Type Unspecified