Individual
DR. CRISTIAN MAURICIO THOMAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
171 ASHLEY AVE, CHARLESTON, SC 29425-8908
(843) 792-1414
Mailing address
PO BOX 751461, CHARLOTTE, NC 28275-1461
(843) 792-6200
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
032825
GA
207V00000X
Obstetrics & Gynecology Physician
Primary
37841
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00427237C
—
GA
01
—
032825
LICENSE
GA
01
—
52022921
BCBS GA PROVIDER NUMBER
GA
01
—
G32825
SC MEDICAID
SC
Enumeration date
10/11/2006
Last updated
06/23/2015
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