MEDICARE: DR. THOMAS P OFFICER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	0101037103	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1100499769	OTHER	VA	RAILROAD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00414803	OTHER	VA	AETNA
4	094198	OTHER	VA	ANTHEM BC BS

General Provider Information

NPI Number	:	1003885898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS P OFFICER M.D.

Provider Business Mailing Address
First Line	:	101 PARK HILL DR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-3357
Country	:	US
Telephone Number	:	540-371-3010
Fax Number	:	540-899-9821

Provider Business Practice Location Address
First Line	:	101 PARK HILL DR
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22401-3357
Country	:	US
Telephone Number	:	540-371-3010
Fax Number	:	540-899-9821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	11/13/2008

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