Healthcare Provider Details

I. General information

NPI: 1871505768
Provider Name (Legal Business Name): POTTAYIL VARKEY THOMAS M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 ALGONQUIN RD
NORFOLK VA
23505-3173
US

IV. Provider business mailing address

PO BOX 9170
NORFOLK VA
23505-0170
US

V. Phone/Fax

Practice location:
  • Phone: 757-440-9000
  • Fax:
Mailing address:
  • Phone: 757-440-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101022389
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number0101022389
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: