Healthcare Provider Details

I. General information

NPI: 1992720510
Provider Name (Legal Business Name): THOMAS W PAYNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11835 FISHING POINT DR STE 207
NEWPORT NEWS VA
23606
US

IV. Provider business mailing address

11835 FISHING POINT DR STE 207
NEWPORT NEWS VA
23606
US

V. Phone/Fax

Practice location:
  • Phone: 757-893-3334
  • Fax: 757-873-1128
Mailing address:
  • Phone: 757-893-3334
  • Fax: 757-873-1128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number0101016614
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: