MEDICARE: CORNELIUS W. 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
1	101YM0800X	Mental Health Counselor	7890	HI
2	2084P0800X	Psychiatry Physician	0101238268	VA

General Provider Information

NPI Number	:	1578565289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORNELIUS W. THOMAS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 800623
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	LEE ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0001
Country	:	US
Telephone Number	:	434-924-2241
Fax Number	:

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

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	02/11/2014

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