Healthcare Provider Details

I. General information

NPI: 1134164239
Provider Name (Legal Business Name): THOMAS G GLEASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 MCDOWELL ST
ASHEVILLE NC
28803-2606
US

IV. Provider business mailing address

257 MCDOWELL ST
ASHEVILLE NC
28803-2606
US

V. Phone/Fax

Practice location:
  • Phone: 828-258-1121
  • Fax: 828-252-6114
Mailing address:
  • Phone: 828-258-1121
  • Fax: 828-252-6114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberMD071478L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036112836
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD91723
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number2022-01004
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: