Provider Demographics
NPI:1730135948
Name:SUVADA, THOMAS M (DC)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:SUVADA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5505 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-5252
Mailing Address - Country:US
Mailing Address - Phone:757-420-5505
Mailing Address - Fax:757-420-3422
Practice Address - Street 1:5505 INDIAN RIVER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-5252
Practice Address - Country:US
Practice Address - Phone:757-420-5505
Practice Address - Fax:757-420-3422
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000690111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA350000256Medicare ID - Type Unspecified
VAT90563Medicare UPIN