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NPI Code Detail

MEDICARE: DR. THOMAS JOSEPH CARRICO M.D.

MEDICARE: DR. THOMAS JOSEPH CARRICO 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
1208200000XPlastic Surgery Physician0101032447VA
2208600000XSurgery Physician0101032447VA
3207PE0005XUndersea and Hyperbaric Medicine (Emergency Medicine) Physician0101032447VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1186304OTHERANTHEM PROVIDER NUMBER
2203639329006OTHERTRICARE PROVIDER NUMBER
390402OTHERSENTARA/OPTIMA PROVIDER N
4329096OTHERSOUTHERN HEALTH PROVIDER

General Provider Information

NPI Number : 1386640266
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. THOMAS JOSEPH CARRICO M.D.
Provider Business Mailing Address
First Line : 1204 FENWICK DR
Second Line :
City : LYNCHBURG
State : VA
Zip : 24502-2112
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3300 RIVERMONT AVE
Second Line :
City : LYNCHBURG
State : VA
Zip : 24503-2030
Country : US
Telephone Number : 434-947-1801
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/24/2005
Last Update Date : 03/11/2008

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