Provider Demographics
NPI:1912688524
Name:THOMAS, DAVID LEE
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5457 BRADLEY PINES CIR APT B
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-2338
Mailing Address - Country:US
Mailing Address - Phone:804-393-4758
Mailing Address - Fax:
Practice Address - Street 1:5457 BRADLEY PINES CIR APT B
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2338
Practice Address - Country:US
Practice Address - Phone:804-393-4758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty