Healthcare Provider Details

I. General information

NPI: 1184608564
Provider Name (Legal Business Name): THOMAS NYGAARD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

IV. Provider business mailing address

2410 ATHERHOLT RD
LYNCHBURG VA
24501-2148
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5252
  • Fax: 434-200-2862
Mailing address:
  • Phone: 434-200-5252
  • Fax: 434-200-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number0101033694
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: