Provider Demographics
NPI:1528095809
Name:DIABETES AND THYROID ASSOCIATES PC
Entity type:Organization
Organization Name:DIABETES AND THYROID ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCCLANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-891-8499
Mailing Address - Street 1:10711 SPOTSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-2674
Mailing Address - Country:US
Mailing Address - Phone:540-891-8499
Mailing Address - Fax:
Practice Address - Street 1:10711 SPOTSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2674
Practice Address - Country:US
Practice Address - Phone:540-891-8499
Practice Address - Fax:540-891-8662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA077372OtherANTHEM BLUE CROSS IDENTIF
VA077372OtherANTHEM BLUE CROSS IDENTIF
VAD93704Medicare UPIN
VA6079041Medicaid