1982656872 NPI number — DR. THOMAS MENDOZA ALABANZA M.D.

Table of content: DR. THOMAS MENDOZA ALABANZA M.D. (NPI 1982656872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982656872 NPI number — DR. THOMAS MENDOZA ALABANZA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALABANZA
Provider First Name:
THOMAS
Provider Middle Name:
MENDOZA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALABANZA
Provider Other First Name:
TOMAS
Provider Other Middle Name:
MENDOZA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982656872
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 1280
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24543-1280
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-791-4648
Provider Business Mailing Address Fax Number:
434-793-2631

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-1828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-791-4648
Provider Business Practice Location Address Fax Number:
434-793-2631
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101022214 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006092683 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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