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NPI Code Detail

MEDICARE: DR. CAROLYN EDMUNDS THOMAS MD

MEDICARE: DR. CAROLYN EDMUNDS THOMAS MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician0101027213VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1224092OTHERVAANTHEM-JAHNKE RD
227826OTHEROPTIMAHEALTH

General Provider Information

NPI Number : 1306846548
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROLYN EDMUNDS THOMAS MD
Provider Business Mailing Address
First Line : PO BOX 36559
Second Line :
City : RICHMOND
State : VA
Zip : 23235-8011
Country : US
Telephone Number : 804-897-4250
Fax Number : 804-897-0670
Provider Business Practice Location Address
First Line : 7101 JAHNKE RD
Second Line :
City : RICHMOND
State : VA
Zip : 23225-4017
Country : US
Telephone Number : 804-323-8820
Fax Number : 804-323-8539
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2005
Last Update Date : 07/09/2007

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