Provider Demographics
NPI:1154355824
Name:PEARSALL, THOMAS BALLOU
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:BALLOU
Last Name:PEARSALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4299 SAN FELIPE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-2916
Mailing Address - Country:US
Mailing Address - Phone:832-476-3900
Mailing Address - Fax:832-476-3990
Practice Address - Street 1:5801 BREMO ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-285-0620
Practice Address - Fax:804-285-0726
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237889207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010206979Medicaid
P00265942OtherRAILROAD MEDICARE
VA022951V16Medicare PIN
P00265942OtherRAILROAD MEDICARE
I32284Medicare UPIN
P00817873Medicare PIN