Healthcare Provider Details

I. General information

NPI: 1831292002
Provider Name (Legal Business Name): THOMAS EDMUND NORTHRUP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 STEPHENSON AVE
SAVANNAH GA
31405-5802
US

IV. Provider business mailing address

6605 ABERCORN ST SUITE 108
SAVANNAH GA
31405-5815
US

V. Phone/Fax

Practice location:
  • Phone: 888-850-5316
  • Fax:
Mailing address:
  • Phone: 912-355-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9355
License Number StateSC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: