Provider Demographics
NPI:1417023490
Name:IRUNGU, THOMAS K (MD, MPH)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:K
Last Name:IRUNGU
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-594-4006
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:300 MT CLEMENT PARK
Practice Address - Street 2:SUITE A
Practice Address - City:TAPPAHANNOCK
Practice Address - State:VA
Practice Address - Zip Code:22560-5098
Practice Address - Country:US
Practice Address - Phone:804-443-8610
Practice Address - Fax:804-443-8620
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417023490Medicaid
VAP00918162Medicare PIN
VAVAA104030Medicare PIN
VAHO2214Medicare UPIN