Provider Demographics
NPI:1033326434
Name:THOMAS, VIRGINIA LEE (MD)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:LEE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:LEE
Other - Last Name:MCCORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1523
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-1523
Mailing Address - Country:US
Mailing Address - Phone:479-571-6038
Mailing Address - Fax:479-582-0222
Practice Address - Street 1:3380 N FUTRALL DR STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703
Practice Address - Country:US
Practice Address - Phone:479-442-7322
Practice Address - Fax:479-442-7379
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5H710OtherAR BC/BS
AR181555001Medicaid
AR5H710OtherAR BC/BS
AR5AE41F430Medicare PIN