Healthcare Provider Details

I. General information

NPI: 1184845026
Provider Name (Legal Business Name): THOMAS MAXWELL GEDDINGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 05/23/2024
Certification Date: 05/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 N ROAD ST
ELIZABETH CITY NC
27909
US

IV. Provider business mailing address

1144 N ROAD ST
ELIZABETH CITY NC
27909-3473
US

V. Phone/Fax

Practice location:
  • Phone: 252-335-0531
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number102030
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5487
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2010-01330
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: