Healthcare Provider Details

I. General information

NPI: 1033409016
Provider Name (Legal Business Name): MR. WILLIAM CHRISTOPHER THOMSEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1641 MILLWOOD DR
SALEM VA
24153-4616
US

IV. Provider business mailing address

1641 MILLWOOD DR
SALEM VA
24153-4616
US

V. Phone/Fax

Practice location:
  • Phone: 434-907-3296
  • Fax:
Mailing address:
  • Phone: 434-907-3296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9757995-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number9757995-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: