Individual
MARK ALLEN THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
620 JOHN PAUL JONES CIR, PORTSMOUTH, VA 23708-2111
(757) 953-3420
Mailing address
220 BRIDGEVIEW CIR, CHESAPEAKE, VA 23322-4014
(843) 263-4188
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
4704220074
MI
363LA2100X
Acute Care Nurse Practitioner
Primary
4704220074
MI
Other
Enumeration date
12/21/2006
Last updated
09/10/2012
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