Healthcare Provider Details

I. General information

NPI: 1265441166
Provider Name (Legal Business Name): THOMAS CHARLES GUIRKIN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS C GUIRKIN JR. MD

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 GODWIN BLVD FL 1
SUFFOLK VA
23434-8038
US

IV. Provider business mailing address

2800 GODWIN BLVD FL 1
SUFFOLK VA
23434-8038
US

V. Phone/Fax

Practice location:
  • Phone: 757-934-4821
  • Fax: 757-934-4276
Mailing address:
  • Phone: 757-934-4821
  • Fax: 757-934-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101240216
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101240216
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: