Healthcare Provider Details

I. General information

NPI: 1962553545
Provider Name (Legal Business Name): DR. ALEXANDER RANDOLPH THOMAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LEX THOMAS M.D.

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 COMMERCE RD SUITE 421
STAUNTON VA
24401-4446
US

IV. Provider business mailing address

365 IVY VISTA DR
CHARLOTTESVILLE VA
22903-7434
US

V. Phone/Fax

Practice location:
  • Phone: 540-885-8143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241076
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: