Provider Demographics
NPI:1992736698
Name:TOMLIN, HENRY LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:LOUIS
Last Name:TOMLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5815
Mailing Address - Country:US
Mailing Address - Phone:804-732-0136
Mailing Address - Fax:804-861-9661
Practice Address - Street 1:600 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5815
Practice Address - Country:US
Practice Address - Phone:804-732-0136
Practice Address - Fax:804-861-9661
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101029081207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA541601754OtherINSURANCE - ALL OTHERS
VA006259618Medicaid
VA212033OtherINSURANCE - CIGNA
VA213198OtherINSURANCE - OPTIMUM/MDIPA
VA070725OtherINSURANCE - ANTHEM
VA213198OtherINSURANCE - OPTIMUM/MDIPA
VA006259618Medicaid