Individual
THOMAS E MITORAJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
109 MEADOW VIEW RD, STE 3, BRISTOL, TN 37620-1661
(423) 968-4007
(423) 652-2590
Mailing address
PO BOX 632476, CINCINNATI, OH 45263-2476
(423) 968-4007
(423) 652-2590
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
021345
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006746080
—
VA
01
—
042029
ANTHEM
VA
01
—
123498
BLUE CROSS TN
TN
05
—
3060577
—
TN
Enumeration date
05/12/2006
Last updated
02/17/2025
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