1992796122 NPI number — DANIEL N THOMAS DPM

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	THOMAS
Provider First Name	:	DANIEL
Provider Middle Name	:	N
Provider Name Prefix Text	:
Provider Name Suffix Text	:
Provider Credential Text	:	DPM
Provider Gender Code	:	M

Provider Other Organization Name	:
Provider Other Organization Name Type Code	:
Provider Other Last Name	:
Provider Other First Name	:
Provider Other Middle Name	:
Provider Other Name Prefix Text	:
Provider Other Name Suffix Text	:
Provider Other Credential Text	:
Provider Other Last Name Type Code	:

NPI Number	:	1992796122
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/31/2008
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	PO BOX 6055
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	RICHMOND
Provider Business Mailing Address State Name	:	VA
Provider Business Mailing Address Postal Code	:	23222-0055
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	804-329-0420
Provider Business Mailing Address Fax Number	:	804-321-6626

Provider First Line Business Practice Location Address	:	2505 CHAMBERLAYNE AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	RICHMOND
Provider Business Practice Location Address State Name	:	VA
Provider Business Practice Location Address Postal Code	:	23222-4214
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	804-329-0420
Provider Business Practice Location Address Fax Number	:	804-321-6626
Provider Enumeration Date	:	11/05/2005

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

• Taxonomy code: 213E00000X , with the licence number:  0103000390 , registered in the state of VA .
• Taxonomy code: 213ES0131X , with the licence number: 0103000390 , registered in the state of VA .

• Identifier: 009301194 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 430509 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 480000605 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: T21750 , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 009301194 . This is a "VA PREMIER" identifier , issued by the state of ( VA ) . This identifiers is of the category "".
• Identifier: 480026291 , issued by the state of ( VA ) . This identifiers is of the category "".