Healthcare Provider Details

I. General information

NPI: 1487637989
Provider Name (Legal Business Name): THOMAS PAUL MARCOTTE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 06/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

298 MEMORIAL DR
SENECA SC
29672-9443
US

IV. Provider business mailing address

1 INDEPENDENCE PT SUITE 212
GREENVILLE SC
29615-4545
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-3351
  • Fax: 864-885-7619
Mailing address:
  • Phone: 864-797-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN2122
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: