Healthcare Provider Details

I. General information

NPI: 1982938858
Provider Name (Legal Business Name): AARON ROBERT THOMAS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 03/30/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 108
RALEIGH NC
27607-7522
US

IV. Provider business mailing address

4414 LAKE BOONE TRL STE 108
RALEIGH NC
27607-7522
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-2300
  • Fax: 919-784-2301
Mailing address:
  • Phone: 919-784-2300
  • Fax: 919-784-2301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0010-01995
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: