Provider Demographics
NPI:1144235953
Name:BAHLEDA, THOMAS ANTHONY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:BAHLEDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5791
Mailing Address - Fax:540-564-7038
Practice Address - Street 1:235 CANTRELL AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3248
Practice Address - Country:US
Practice Address - Phone:540-564-7364
Practice Address - Fax:540-564-7365
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
180765OtherANTHEM/BCBS
322621OtherSOUTHERN HEALTH
WV3810003095OtherWV MEDICAID
VA010197473Medicaid
VA97056OtherOPTIMA
P00269548OtherRAILROAD MEDICARE
VA8411004OtherCIGNA
VA1000870001OtherDME PROVIDER
VA8411004OtherCIGNA
WV3810003095OtherWV MEDICAID
VA1000870001OtherDME PROVIDER