Healthcare Provider Details

I. General information

NPI: 1811682487
Provider Name (Legal Business Name): THOMAS DAULTON BOPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HOSPITAL DR
MONROE NC
28112-6000
US

IV. Provider business mailing address

600 HOSPITAL DR
MONROE NC
28112-6000
US

V. Phone/Fax

Practice location:
  • Phone: 980-993-3100
  • Fax:
Mailing address:
  • Phone: 980-993-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2026-01110
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: