Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 31752 | SC |
N | 207PE0004X | Emergency Medical Services | 31752 | SC |
NPI | 1023255858 |
---|---|
Provider Name | Dr. Mathew Kadalikattil Thomas |
First Address | Mc Coll, SC 29570-5001 |
Second Address | Bennettsville, SC 29512-2466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2009 |
Last Update Date | 01/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
317525 | (05) | RI |