Healthcare Provider Details

I. General information

NPI: 1871754028
Provider Name (Legal Business Name): RADHIKA M. THORN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14051 ST FRANCIS BLVD STE 2210
MIDLOTHIAN VA
23114-3203
US

IV. Provider business mailing address

14051 ST FRANCIS BLVD STE 2210
MIDLOTHIAN VA
23114-3203
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8717
  • Fax: 804-594-3131
Mailing address:
  • Phone: 804-893-8717
  • Fax: 804-594-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD.206960
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101262562
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: