Provider Demographics
NPI:1730186883
Name:THOMAS, DENNIS (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:
Last Name:THOMAS
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 1:4630 S LABURNUM AVE
Mailing Address - Street 2:STE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2441
Mailing Address - Country:US
Mailing Address - Phone:804-932-4388
Mailing Address - Fax:804-932-9860
Practice Address - Street 1:1850 POCAHONTAS TRL
Practice Address - Street 2:
Practice Address - City:QUINTON
Practice Address - State:VA
Practice Address - Zip Code:23141-1657
Practice Address - Country:US
Practice Address - Phone:804-932-4388
Practice Address - Fax:804-932-9860
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5623251Medicaid
BO7335Medicare UPIN
080002095Medicare ID - Type Unspecified