Provider Demographics
NPI:1700885035
Name:FLEETER, THOMAS B (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:FLEETER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-435-6604
Mailing Address - Fax:703-787-6575
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-435-6604
Practice Address - Fax:703-787-6575
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101033156207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024732T99Medicare PIN
VAB92822Medicare UPIN