Healthcare Provider Details

I. General information

NPI: 1881315919
Provider Name (Legal Business Name): LAWRENCE O THIGPEN III HIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E LEIGH ST RM 14-015
RICHMOND VA
23298-5004
US

IV. Provider business mailing address

7001 FERNWOOD ST APT 621
RICHMOND VA
23228-4020
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-7923
  • Fax: 804-807-7950
Mailing address:
  • Phone: 804-536-1816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number2101002612
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: