Thomas Green, M.D.
Individual provider Active NPI Internal Medicine Physician · Moyock, NC
NPI 1003902008 · NPPES record last updated Nov 23, 2020
Key facts
- NPI
- 1003902008
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 01-01054 (NC)
- Practice address
- 534 Caratoke Hwy
Moyock, NC 27958-8740 - Phone
- (252) 435-6621
- Fax
- (252) 435-2685
- NPI assigned
- Oct 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171130002980 | WV | Practitioner - Hospitalist |
1456343292 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01-01054 | NC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospitalist Medicine Physicians of West Virginia, PLLC | Internal Medicine | Current |
Accepting new patients |
| Rutherford Internal Medicine Associates PA | Internal Medicine | Past | Accepting new patients |
Locations
2500 Hospital Dr
Martinsburg, WV 25401
Phone (304) 233-4134
4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 01-01054 | NC | Yes |
Addresses
Primary practice location
534 Caratoke Hwy
Moyock, NC 27958-8740
Mailing address
PO Box 11314
Belfast, ME 04915-4004
Phone (757) 842-4481
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1294M | Other | NC | BCBS OF NC |
| P00115557 | Other | NC | MEDICARE RAILROAD |
| 891294M | Medicaid | NC |
Other providers in Moyock, NC
- Suzanne M Giordano
- Jasmine Goodwin
- Carly Jean Gray
- Richard Scott Gray
- Tammy Lynn Green
- Macy Gregory
- Claudia Hartmann
- Katherine Helepololei
- Angel Hines
- Mark J Hippenstiel
All providers in Moyock, NC · Internal Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.