Healthcare Provider Details

I. General information

NPI: 1215106836
Provider Name (Legal Business Name): SANJAY TOMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

244 MEDSPRING DR
CLAYTON NC
27520-9293
US

IV. Provider business mailing address

244 MEDSPRING DR
CLAYTON NC
27520-9293
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-0291
  • Fax: 919-553-2907
Mailing address:
  • Phone: 919-359-0291
  • Fax: 919-553-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2008-01357
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number2008-01357
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number2008-01357
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number2008-01357
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: