Provider Demographics
NPI:1760457873
Name:KLEVAN, THOMAS (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:KLEVAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 BUSINESS PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6535
Mailing Address - Country:US
Mailing Address - Phone:757-962-1083
Mailing Address - Fax:757-962-1254
Practice Address - Street 1:100 KINGSLEY LN
Practice Address - Street 2:SUITE 200
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4604
Practice Address - Country:US
Practice Address - Phone:757-889-6768
Practice Address - Fax:757-962-1254
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101040686207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0518POtherBC/BS NC
VA086977OtherANTHEM BC/BS
VA263654OtherUHC/MAMSI/MDIPA
VAPAROtherAETNA
VA006033440Medicaid
VA15602OtherOPTIMA HEALTH PLAN
VA250467OtherATHEM BC/BS VA/HK
VAPAROtherVIRGINIA HEALTH NETWORK
VA006096166Medicaid
VA15792OtherSENTARA OHP/SHP
NC890518PMedicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherUSA MANAGED CARE
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherCIGNA
VA249500OtherMAMSI
VAPAROtherTRICARE/CHAMPUS
VAPAROtherMULTIPLAN
VA263654OtherUHC/MAMSI/MDIPA
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA HEALTH NETWORK
VA060000673Medicare PIN