Healthcare Provider Details

I. General information

NPI: 1689613994
Provider Name (Legal Business Name): DILIP ABRAHAM THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PELHAM RD
GREENVILLE SC
29615-3111
US

IV. Provider business mailing address

PO BOX 896189
CHARLOTTE NC
28289-6189
US

V. Phone/Fax

Practice location:
  • Phone: 864-654-6706
  • Fax:
Mailing address:
  • Phone: 864-654-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number047273
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number047273
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: