Healthcare Provider Details

I. General information

NPI: 1144235953
Provider Name (Legal Business Name): THOMAS ANTHONY BAHLEDA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 CANTRELL AVE
HARRISONBURG VA
22801-3248
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 540-564-7364
  • Fax: 540-564-7365
Mailing address:
  • Phone: 540-564-5791
  • Fax: 540-564-7038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101238634
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: