Provider Demographics
NPI:1730157025
Name:THORNTON, CHARLOTTE LYNN (MD)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LYNN
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12715 WARWICK BLVD
Practice Address - Street 2:SUITE O
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-1800
Practice Address - Country:US
Practice Address - Phone:757-930-0091
Practice Address - Fax:757-269-4406
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2013-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101231111207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730157025Medicaid
VAP01202923OtherRAILROAD MEDICARE
VAH81840Medicare UPIN
VAP01202923OtherRAILROAD MEDICARE