Healthcare Provider Details

I. General information

NPI: 1447256854
Provider Name (Legal Business Name): THOMAS FRANCIS TRAHEY III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1028 LEE ANN DR NE SUITE 100
CONCORD NC
28025-2903
US

IV. Provider business mailing address

1718 E 4TH ST SUITE 501
CHARLOTTE NC
28204-3261
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-5353
  • Fax: 704-316-5354
Mailing address:
  • Phone: 704-343-9800
  • Fax: 704-347-2011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number30749
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30749
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: