Provider Demographics
NPI:1689613994
Name:THOMAS, DILIP ABRAHAM (MD)
Entity type:Individual
Prefix:
First Name:DILIP
Middle Name:ABRAHAM
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 896189
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6189
Mailing Address - Country:US
Mailing Address - Phone:864-654-6706
Mailing Address - Fax:
Practice Address - Street 1:360 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3111
Practice Address - Country:US
Practice Address - Phone:864-654-6706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047273207WX0200X, 207W00000X, 207WX0200X
SC90732207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000831707EMedicaid
GA000831707FMedicaid
SCG47273Medicaid
GA10053866OtherAMERIGROUP
GA349833OtherWELLCARE OF GA
GA18BDGNMMedicare PIN
GA349833OtherWELLCARE OF GA
GA000831707FMedicaid
GAP00342988Medicare PIN
GA0412940004Medicare NSC
GA0412940001Medicare NSC
GA000831707EMedicaid
G56089Medicare UPIN