Healthcare Provider Details

I. General information

NPI: 1366770547
Provider Name (Legal Business Name): PHILIP R THOMAS MD., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 KINGS HWY
SUFFOLK VA
23432-1117
US

IV. Provider business mailing address

112 KINGS HWY PO BOX 2068
SUFFOLK VA
23432-1117
US

V. Phone/Fax

Practice location:
  • Phone: 757-255-4224
  • Fax: 757-255-4124
Mailing address:
  • Phone: 757-255-4224
  • Fax: 757-255-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0101011438
License Number StateVA

VIII. Authorized Official

Name: PHILIP R THOMAS
Title or Position: PHYSICIAN
Credential:
Phone: 757-255-4224