Healthcare Provider Details

I. General information

NPI: 1154378495
Provider Name (Legal Business Name): IAN H THORNEYCROFT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 HILLWOOD RD
MOBILE AL
36608-2311
US

IV. Provider business mailing address

21 HILLWOOD RD
MOBILE AL
36608-2311
US

V. Phone/Fax

Practice location:
  • Phone: 516-484-3222
  • Fax:
Mailing address:
  • Phone: 516-484-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number15135
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number15135
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: