Healthcare Provider Details

I. General information

NPI: 1386617389
Provider Name (Legal Business Name): EDWARD ARMISTEAD THOMAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 12/29/2024
Certification Date: 12/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2533 NOTTINGHAM RD SE
ROANOKE VA
24014-3409
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-377-1466
  • Fax:
Mailing address:
  • Phone: 757-686-3516
  • Fax: 757-686-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMTL-2024-023
License Number StateGU
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101041528
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: