Provider Demographics
NPI:1124083498
Name:HOLTHUS, THOMAS EDWARD (DO)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:HOLTHUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33674 OLD VALLEY PIKE
Mailing Address - Street 2:
Mailing Address - City:STRASBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22657-3704
Mailing Address - Country:US
Mailing Address - Phone:540-465-3751
Mailing Address - Fax:540-465-5008
Practice Address - Street 1:33674 OLD VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:STRASBURG
Practice Address - State:VA
Practice Address - Zip Code:22657-3704
Practice Address - Country:US
Practice Address - Phone:540-465-3751
Practice Address - Fax:540-465-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005617359Medicaid
VA080163009OtherMCRR PTAN
VA00V212M13Medicare PIN
VA005617359Medicaid