MEDICARE: PHILLIP RAY THOMASON 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	208000000X	Pediatrics Physician	0101023436	VA

Other Identifiers

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

General Provider Information

NPI Number	:	1699731992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP RAY THOMASON MD

Provider Business Mailing Address
First Line	:	2000 MEADE PARKWAY
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4259
Country	:	US
Telephone Number	:	757-539-0251
Fax Number	:	757-923-9610

Provider Business Practice Location Address
First Line	:	4868 BRIDGE ROAD
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-2048
Country	:	US
Telephone Number	:	757-483-7900
Fax Number	:	757-483-7151

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	05/14/2009

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