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NPI Code Detail

MEDICARE: DR. PETRA THOMAS M.D.

MEDICARE: DR. PETRA THOMAS 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
1207RP1001XPulmonary Disease Physician0101235337VA
2207RP1001XPulmonary Disease PhysicianD48133MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A6950006OTHERDCDC BS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518957661
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PETRA THOMAS M.D.
Provider Business Mailing Address
First Line : PO BOX 1400
Second Line :
City : FAIRFAX
State : VA
Zip : 22038-1400
Country : US
Telephone Number : 703-383-9543
Fax Number : 703-383-9532
Provider Business Practice Location Address
First Line : 7211 BANK CT
Second Line :
City : FREDERICK
State : MD
Zip : 21703-8483
Country : US
Telephone Number : 240-215-6310
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2005
Last Update Date : 09/22/2022

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