MEDICARE: DR. MARK T THORNE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	34481	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326000613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK T THORNE M.D.

Provider Business Mailing Address
First Line	:	7036 ORCHARD PATH DR
Second Line	:
City	:	CLEMMONS
State	:	NC
Zip	:	27012-8222
Country	:	US
Telephone Number	:	336-766-6289
Fax Number	:

Provider Business Practice Location Address
First Line	:	2933 MAPLEWOOD AVE
Second Line	:	4
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-4001
Country	:	US
Telephone Number	:	336-765-0155
Fax Number	:	336-765-5494

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2006
Last Update Date	:	07/08/2007

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