Healthcare Provider Details

I. General information

NPI: 1669457677
Provider Name (Legal Business Name): THOMAS RICHERSON MILAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 08/01/2024
Certification Date: 08/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2017 JEFFERSON ST SW FL 2
ROANOKE VA
24014-2419
US

IV. Provider business mailing address

2752 JEFFERSON ST SE
ROANOKE VA
24014-3318
US

V. Phone/Fax

Practice location:
  • Phone: 910-616-9192
  • Fax:
Mailing address:
  • Phone: 540-795-2529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberR6442
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number166864
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101226833
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberMD187125
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number63624
License Number StateMN
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number115-320
License Number StateWI
# 7
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2018032731
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD60850087
License Number StateWA
# 9
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC172244
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: