=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447200738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES CARROLL THOMAS II MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/10/2006
-----------------------------------------------------
Last Update Date | 12/09/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 HOSPITAL DR SUITE 10
-----------------------------------------------------
City | CLYDE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28721-8046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-452-2320
-----------------------------------------------------
Fax | 828-456-4707
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 E FOREST RD
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28803-2909
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-274-8238
-----------------------------------------------------
Fax | 828-274-5157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 000016959
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------