Basic Information
| Provider Information | |||||||||
| NPI: | 1437118338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAUTMANN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | G. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1420 E 7TH ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282042408 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043750100 | ||||||||
| FaxNumber: | 7043758623 | ||||||||
| Practice Location | |||||||||
| Address1: | 1057 RED VENTURES DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | FORT MILL | ||||||||
| State: | SC | ||||||||
| PostalCode: | 297072518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8035483708 | ||||||||
| FaxNumber: | 8034312249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2006 | ||||||||
| LastUpdateDate: | 12/27/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 21301 | SC | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | 30104 | NC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 84865 | 01 | NC | MEDCOST | OTHER | 8983701 | 05 | NC | MEDICAID | 1170F | 01 | NC | BLUE CROSS | OTHER | 2086657 | 01 | NC | UNITED HEALTHCARE | OTHER | N30104 | 05 | SC | MEDICAID | 6225 | 01 | NC | PARTNERS | OTHER | 1818082007 | 01 | NC | CIGNA | OTHER |