Provider Demographics
NPI:1902063423
Name:THOMAS, MEGAN CORNWELL (DO)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:CORNWELL
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HICKOK ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3524
Mailing Address - Country:US
Mailing Address - Phone:540-382-6148
Mailing Address - Fax:540-382-4191
Practice Address - Street 1:6 HICKOK ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3524
Practice Address - Country:US
Practice Address - Phone:540-382-6148
Practice Address - Fax:540-382-4191
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102203075207R00000X, 208000000X
PAOT012237207R00000X, 208000000X
PAOS015488207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1902063423Medicaid
VAVV8289AMedicare PIN
VA1902063423Medicaid