Provider Demographics
NPI:1366770547
Name:PHILIP R THOMAS MD., LTD
Entity type:Organization
Organization Name:PHILIP R THOMAS MD., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-255-4224
Mailing Address - Street 1:112 KINGS HWY
Mailing Address - Street 2:PO BOX 2068
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23432-1117
Mailing Address - Country:US
Mailing Address - Phone:757-255-4224
Mailing Address - Fax:757-255-4124
Practice Address - Street 1:112 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23432-1117
Practice Address - Country:US
Practice Address - Phone:757-255-4224
Practice Address - Fax:757-255-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101011438173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5613311Medicaid
VA178791OtherATHEM
VA011896072Medicare PIN
VA5613311Medicaid