Healthcare Provider Details

I. General information

NPI: 1235263971
Provider Name (Legal Business Name): THOMAS KERN CARLTON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2610 E 7TH ST
CHARLOTTE NC
28204-4375
US

IV. Provider business mailing address

2610 E 7TH ST
CHARLOTTE NC
28204-4375
US

V. Phone/Fax

Practice location:
  • Phone: 704-375-8900
  • Fax: 704-335-7178
Mailing address:
  • Phone: 704-375-8900
  • Fax: 704-335-7178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number9300056
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: