Provider Demographics
NPI:1962670869
Name:THORNTON, PATRICK K (SA-C)
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:K
Last Name:THORNTON
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 KING CHARLES CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-1905
Mailing Address - Country:US
Mailing Address - Phone:804-320-0866
Mailing Address - Fax:
Practice Address - Street 1:1506 KING CHARLES CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-1905
Practice Address - Country:US
Practice Address - Phone:804-320-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA08-106246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant