Healthcare Provider Details

I. General information

NPI: 1891790838
Provider Name (Legal Business Name): THOMAS MICHAEL TRUITT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 WILBORN AVE
SOUTH BOSTON VA
24592-3120
US

IV. Provider business mailing address

2232 WILBORN AVE STE B
SOUTH BOSTON VA
24592-1662
US

V. Phone/Fax

Practice location:
  • Phone: 434-572-6935
  • Fax: 434-572-4827
Mailing address:
  • Phone: 434-572-5260
  • Fax: 434-575-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101054633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: