Healthcare Provider Details

I. General information

NPI: 1215907993
Provider Name (Legal Business Name): THOMAS H GROTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1913 W PARK DR
N WILKESBORO NC
28659-3564
US

IV. Provider business mailing address

PO BOX 60516
CHARLOTTE NC
28260-0516
US

V. Phone/Fax

Practice location:
  • Phone: 336-903-6362
  • Fax: 336-903-6354
Mailing address:
  • Phone: 336-903-6362
  • Fax: 336-903-6354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number31138
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: