Healthcare Provider Details

I. General information

NPI: 1962670869
Provider Name (Legal Business Name): PATRICK K THORNTON SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 KING CHARLES CT
RICHMOND VA
23236-1905
US

IV. Provider business mailing address

1506 KING CHARLES CT
RICHMOND VA
23236-1905
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-0866
  • Fax:
Mailing address:
  • Phone: 804-320-0866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number08-106
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: