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NPI Code Detail

MEDICARE: MS. ANN HOLLAND THOMAS P.A.

MEDICARE: MS. ANN HOLLAND THOMAS P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant102797NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2970022604OTHERNCRAILROAD MEDICARE PROV #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1B1828OTHERNCMEDCOST INDIVIDUAL PROV#

General Provider Information

NPI Number : 1891723425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ANN HOLLAND THOMAS P.A.
Provider Business Mailing Address
First Line : PO BOX 36488
Second Line :
City : CHARLOTTE
State : NC
Zip : 28236-6488
Country : US
Telephone Number : 704-248-3400
Fax Number : 704-337-8387
Provider Business Practice Location Address
First Line : 201 QUEENS RD
Second Line :
City : CHARLOTTE
State : NC
Zip : 28204-3217
Country : US
Telephone Number : 704-372-5180
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 06/21/2016

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