Individual
DR. TOM PRAKASH THERUVATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
301 HAWTHORNE LANE, SUITE 200, CHARLOTTE, NC 28204-2467
(704) 316-5100
(704) 316-5101
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5100
(704) 316-5101
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2015-01140
NC
208600000X
Surgery Physician
LL 30838
SC
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
2015-01140
NC
Other
Enumeration date
06/22/2008
Last updated
10/25/2020
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