Provider Demographics
NPI:1356347140
Name:BOEKER, THOMAS WHITEFORD (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WHITEFORD
Last Name:BOEKER
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 1:3973B MARKET ST
Mailing Address - Street 2:BLDG. D
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-1403
Mailing Address - Country:US
Mailing Address - Phone:910-763-0699
Mailing Address - Fax:
Practice Address - Street 1:3973B MARKET ST
Practice Address - Street 2:BLDG. D
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-1403
Practice Address - Country:US
Practice Address - Phone:910-763-0699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-011802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH 09449Medicare UPIN