Healthcare Provider Details

I. General information

NPI: 1881739381
Provider Name (Legal Business Name): THOMAS J. MONROE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 KIT CREEK RD.
MORRISVILLE NC
27560
US

IV. Provider business mailing address

PO BOX 110315 SEQUENOM CMM
DURHAM NC
27709
US

V. Phone/Fax

Practice location:
  • Phone: 616-550-6079
  • Fax: 919-472-4602
Mailing address:
  • Phone: 616-550-6079
  • Fax: 919-472-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: