Basic Information
| Provider Information | |||||||||
| NPI: | 1760433817 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WARCUP | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | KENNETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 208 VILLAGE WALK DR | ||||||||
| Address2: | SUITE C140 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275407681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195528911 | ||||||||
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| Practice Location | |||||||||
| Address1: | 208 VILLAGE WALK DR | ||||||||
| Address2: | SUITE C140 | ||||||||
| City: | HOLLY SPRINGS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275407681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195528911 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 08/31/2011 | ||||||||
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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 | 207Q00000X | DO 00533 | RI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7009038 | 05 | RI | MEDICAID |