Vandiver, Thomas Jackson

Vandiver, Thomas Jackson is an individual health care provider with primary practice located at 150 Providence Rd , Charlotte NC 28207-1218. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecology, which is considered as his primary health care specialty. Vandiver, Thomas Jackson can be contacted via phone (704) 973-2106.

Contact Information

Primary practice address
150 Providence Rd Charlotte NC 28207-1218
Phone: (704) 973-2106
Fax: (704) 973-2395
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 24305 North Carolina

Profile Details

NPI number 1902896756
LBN Legal business name Vandiver, Thomas Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Mar 11th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1902896756 NPPES
North Carolina MEDICAID 8984676

Popular Providers