MEDICARE: DR. BRANT 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	207QA0505X	Adult Medicine Physician	0101036896	VA

General Provider Information

NPI Number	:	1730155862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRANT THOMAS M.D.

Provider Business Mailing Address
First Line	:	1821 OLD DONATION PKWY
Second Line	:	SUITE 4
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-481-3770
Fax Number	:	757-496-4905

Provider Business Practice Location Address
First Line	:	1821 OLD DONATION PKWY
Second Line	:	SUITE 4
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-481-3770
Fax Number	:	757-496-4905

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/08/2007

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