Healthcare Provider Details

I. General information

NPI: 1538126255
Provider Name (Legal Business Name): THOMAS S. MARLOWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BILLINGSLEY RD STE 104
CHARLOTTE NC
28211-1066
US

IV. Provider business mailing address

411 BILLINGSLEY RD STE 104
CHARLOTTE NC
28211-1066
US

V. Phone/Fax

Practice location:
  • Phone: 704-348-4000
  • Fax: 704-927-2952
Mailing address:
  • Phone: 704-348-4000
  • Fax: 704-927-2952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number200500082
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number200500082
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: