Provider Demographics
NPI:1699884734
Name:HUNTER, THOMAS RYAN (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RYAN
Last Name:HUNTER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 GLENN MITCHELL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0168
Mailing Address - Country:US
Mailing Address - Phone:757-507-0600
Mailing Address - Fax:
Practice Address - Street 1:1950 GLENN MITCHELL DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0168
Practice Address - Country:US
Practice Address - Phone:757-507-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002113363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
008607T83Medicare ID - Type Unspecified
Q52193Medicare UPIN