MEDICARE: MR. WILLIAM CHRISTOPHER THOMSEN JR.

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	208000000X	Pediatrics Physician	9757995-1205	UT
2	2080P0207X	Pediatric Hematology & Oncology Physician	9757995-1205	UT

General Provider Information

NPI Number	:	1033409016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM CHRISTOPHER THOMSEN JR.

Provider Business Mailing Address
First Line	:	1641 MILLWOOD DR
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-4616
Country	:	US
Telephone Number	:	434-907-3296
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 MILLWOOD DR
Second Line	:
City	:	SALEM
State	:	VA
Zip	:	24153-4616
Country	:	US
Telephone Number	:	434-907-3296
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	12/17/2021

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