Healthcare Provider Details

I. General information

NPI: 1811949613
Provider Name (Legal Business Name): THOMAS IRVING EPPERSON JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 07/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510-A ANDERSON HWY.
POWHATAN VA
23139-7406
US

IV. Provider business mailing address

3000 WATERCOVE RD
MIDLOTHIAN VA
23112-3982
US

V. Phone/Fax

Practice location:
  • Phone: 804-598-3100
  • Fax:
Mailing address:
  • Phone: 804-744-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101030811
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: