Basic Information
| Provider Information | |||||||||
| NPI: | 1639127806 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | STEPHEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043848720 | ||||||||
| FaxNumber: | 7043848747 | ||||||||
| Practice Location | |||||||||
| Address1: | 16525 HOLLY CREST LN STE 150 | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280784911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043848720 | ||||||||
| FaxNumber: | 7043848747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 200900585 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 200900585 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 35-067676 | OH | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 35-067676 | OH | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0381359 | 05 | OH | MEDICAID | 591287 | 05 | NC | MEDICAID | 64952146 | 05 | KY | MEDICAID | 200086330 | 05 | IN | MEDICAID |