MEDICARE: DR. THOMAS R STENNETT III 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
1	207Q00000X	Family Medicine Physician	0101-034416	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	011841	OTHER	VA	ANTHEM
2	56513	OTHER	VA	SOUTHERN HEALTH
3	000010672	OTHER	VA	CIGNA

General Provider Information

NPI Number	:	1447244710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS R STENNETT III MD

Provider Business Mailing Address
First Line	:	436 CLAIRMONT CT STE 105
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1765
Country	:	US
Telephone Number	:	804-748-9071
Fax Number	:	804-768-8626

Provider Business Practice Location Address
First Line	:	12801 IRON BRIDGE RD
Second Line	:	SUITE 200
City	:	CHESTER
State	:	VA
Zip	:	23831-1669
Country	:	US
Telephone Number	:	804-748-9071
Fax Number	:	804-768-8626

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	01/22/2018

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