MEDICARE: DR. THOMAS NORMAN CHEATHAM 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	207Q00000X	Family Medicine Physician	J6376	TX

General Provider Information

NPI Number	:	1053305235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS NORMAN CHEATHAM M.D.

Provider Business Mailing Address
First Line	:	4210 CORDELL ST
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3448
Country	:	US
Telephone Number	:	703-642-2312
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 LUKE AVE SW
Second Line	:
City	:	BOLLING AFB
State	:	DC
Zip	:	20032-6400
Country	:	US
Telephone Number	:	703-642-2312
Fax Number	:

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

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/08/2007

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