Provider Demographics
NPI:1437118338
Name:TRAUTMANN, THOMAS G (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:G
Last Name:TRAUTMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1420 E 7TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2408
Mailing Address - Country:US
Mailing Address - Phone:704-375-0100
Mailing Address - Fax:704-375-8623
Practice Address - Street 1:1057 RED VENTURES DR STE 150
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-2518
Practice Address - Country:US
Practice Address - Phone:803-548-3708
Practice Address - Fax:803-431-2249
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC213012085R0001X
NC301042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC84865OtherMEDCOST
NC8983701Medicaid
NC1170FOtherBLUE CROSS
NC2086657OtherUNITED HEALTHCARE
SCN30104Medicaid
NC6225OtherPARTNERS
NC1818082007OtherCIGNA
SCC868176058Medicare ID - Type UnspecifiedSC MEDICARE
SC920003909Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NC1818082007OtherCIGNA
NC211036GMedicare ID - Type UnspecifiedUNIVERSITY RAD ONC CTR
NC211036EMedicare ID - Type Unspecified
NC84865OtherMEDCOST
NC211036JMedicare ID - Type UnspecifiedLAKE NORMAN RAD ONC CTR