Individual
THOMAS CARROLL IDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1250 E MARSHALL ST, INTERNAL MEDICINE, RICHMOND, VA 23298-5051
(804) 828-2161
(804) 828-3673
Mailing address
PO BOX 91734, RICHMOND, VA 23291-1734
(804) 358-6100
(804) 342-7619
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0101243950
VA
207RP1001X
Pulmonary Disease Physician
Primary
0101243950
VA
Other
Enumeration date
05/17/2007
Last updated
07/16/2012
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