Healthcare Provider Details

I. General information

NPI: 1396782512
Provider Name (Legal Business Name): THOMAS E QUIRKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 SEA MOUNTAIN HWY
LITTLE RIVER SC
29566-7861
US

IV. Provider business mailing address

3769 SEA MOUNTAIN HWY
LITTLE RIVER SC
29566-7861
US

V. Phone/Fax

Practice location:
  • Phone: 843-467-5972
  • Fax: 843-507-8732
Mailing address:
  • Phone: 843-467-5972
  • Fax: 843-507-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number21736
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number21736
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: