Provider Demographics
NPI:1306954094
Name:THOMAS M. TRUITT, M.D.P.C.
Entity type:Organization
Organization Name:THOMAS M. TRUITT, M.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:TRUITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-572-5260
Mailing Address - Street 1:2232 WILBORN AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1662
Mailing Address - Country:US
Mailing Address - Phone:434-476-1819
Mailing Address - Fax:
Practice Address - Street 1:2232 WILBORN AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1662
Practice Address - Country:US
Practice Address - Phone:434-476-1819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010546332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA435519OtherANTHEM
VA89150OtherSENTARA
VAF15026Medicare UPIN