Individual
THOMAS EDWARD SUMNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
Primary
21126
NC
2085R0202X
Diagnostic Radiology Physician
21126
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207680000
—
WV
01
—
2118
PARTNERS
—
01
—
370020947
RR MEDICARE
—
01
—
4245108
AETNA
—
01
—
64191
MEDCOST
—
05
—
7230176
—
VA
01
—
80993
BCBS
—
05
—
8980993
—
NC
05
—
Q21126
—
SC
Enumeration date
12/07/2005
Last updated
05/13/2016
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