Basic Information
| Provider Information | |||||||||
| NPI: | 1447256854 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRAHEY | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | FRANCIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1718 E 4TH ST | ||||||||
| Address2: | SUITE 501 | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282043261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043439800 | ||||||||
| FaxNumber: | 7043472011 | ||||||||
| Practice Location | |||||||||
| Address1: | 1028 LEE ANN DR NE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | CONCORD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280252903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043165353 | ||||||||
| FaxNumber: | 7043165354 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
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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 | 174400000X | 30749 | NC | N | Other Service Providers | Specialist | 207RC0000X | 30749 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 83707 | 01 | NC | BLUE CROSS BLUE SHIELD | OTHER | 893707 | 05 | NC | MEDICAID | 287188 | 01 | MAMSI | OTHER | 561845661 | 01 | CHAMPUS | OTHER | 9454 | 01 | PARTNERS | OTHER |