Healthcare Provider Details

I. General information

NPI: 1639382666
Provider Name (Legal Business Name): BRINDA THIMMAPPA M.D., M.B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 N ELM ST STE 100
GREENSBORO NC
27401-6303
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-0200
  • Fax: 336-713-0202
Mailing address:
  • Phone: 336-716-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number2014-00674
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD60084893
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: