Healthcare Provider Details

I. General information

NPI: 1467452706
Provider Name (Legal Business Name): THOMAS J O NEILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 EXECUTIVE DR SUITE F
DANVILLE VA
24541-4160
US

IV. Provider business mailing address

159 EXECUTIVE DR SUITE F
DANVILLE VA
24541-4160
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-4378
  • Fax: 434-799-0860
Mailing address:
  • Phone: 434-792-4378
  • Fax: 434-799-0860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number010121076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: