Healthcare Provider Details

I. General information

NPI: 1548158785
Provider Name (Legal Business Name): WILLIAM CHARLES THOMAS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/26/2025
Certification Date: 06/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR STE 2D
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

2307 N CLEVELAND AVE
CHICAGO IL
60614-3315
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-2438
  • Fax:
Mailing address:
  • Phone: 860-895-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001283415
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: