Provider Demographics
NPI:1871541250
Name:CARRINO, THOMAS (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CARRINO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-5821
Mailing Address - Country:US
Mailing Address - Phone:423-638-1291
Mailing Address - Fax:423-638-9398
Practice Address - Street 1:1410 TUSCULUM BLVD
Practice Address - Street 2:SUITE 2500
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5821
Practice Address - Country:US
Practice Address - Phone:423-638-1291
Practice Address - Fax:423-638-9398
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3373004Medicaid
TNP39716Medicare UPIN
TN103I973100Medicare PIN