Healthcare Provider Details

I. General information

NPI: 1578565289
Provider Name (Legal Business Name): CORNELIUS W. THOMAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEE ST
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

PO BOX 800623
CHARLOTTESVILLE VA
22908-0623
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-2241
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7890
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101238268
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: