Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 25958 | NC |
NPI | 1063433456 |
---|---|
Provider Name | Thomas C Sundberg |
First Address | Charlotte, NC 28260-1643 |
Second Address | Charlotte, NC 28211-4378 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 06/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1063433456 | (05) | NC |
660003567 | MEDICARE-RR (01) | NC |
80105 | BCBSNC (01) | NC |
8980105 | (05) | NC |
D62862 | (02) | NY |
N25958 | (05) | SC |