Provider Demographics
NPI:1760758726
Name:THORNTON, AMANDA VIRGINIA HEYWOOD (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:VIRGINIA HEYWOOD
Last Name:THORNTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 QUALITY DR FL B4
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9494
Mailing Address - Country:US
Mailing Address - Phone:617-414-3779
Mailing Address - Fax:617-414-7062
Practice Address - Street 1:1 QUALITY DR FL B4
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9494
Practice Address - Country:US
Practice Address - Phone:707-624-3473
Practice Address - Fax:707-624-3471
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA120230207RI0200X
MA255112207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty