Healthcare Provider Details

I. General information

NPI: 1801492939
Provider Name (Legal Business Name): MR. ERIC LAMAR THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TECH CENTER PKWY STE 200
NEWPORT NEWS VA
23606-3075
US

IV. Provider business mailing address

11712 JEFFERSON AVE STE C-121
NEWPORT NEWS VA
23606-4406
US

V. Phone/Fax

Practice location:
  • Phone: 757-524-3265
  • Fax:
Mailing address:
  • Phone: 757-524-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: