Healthcare Provider Details

I. General information

NPI: 1659084978
Provider Name (Legal Business Name): THOMAS KEVIN MORGAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W BRAMBLETON AVE STE 100
NORFOLK VA
23510-1115
US

IV. Provider business mailing address

750 BALDWIN AVE APT A6
NORFOLK VA
23517-1829
US

V. Phone/Fax

Practice location:
  • Phone: 757-627-6220
  • Fax: 757-627-0700
Mailing address:
  • Phone: 313-550-3805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110009420
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: