Basic Information
| Provider Information | |||||||||
| NPI: | 1356633390 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARRELL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JACOB HOWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4008 BURNETT WOMACK BLDG CB7228 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198436188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4008 BURNETT WOMACK BLDG CB7228 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198436188 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2011 | ||||||||
| LastUpdateDate: | 11/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | ME153579 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | ME153579 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 2016-00530 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 112516500 | 05 | FL | MEDICAID | OL158 | 01 | FL | MEDICARE HFMG | OTHER | OL159 | 01 | FL | MEDICARE HFPSI | OTHER |