Provider Demographics
NPI:1073504254
Name:WHELAN, THOMAS VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:VINCENT
Last Name:WHELAN
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 1:4560 SOUTH BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1160
Mailing Address - Country:US
Mailing Address - Phone:757-623-0005
Mailing Address - Fax:757-548-1129
Practice Address - Street 1:3009 CORPORATE LN
Practice Address - Street 2:SUITE 210
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9234
Practice Address - Country:US
Practice Address - Phone:757-623-0005
Practice Address - Fax:757-935-1561
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032614207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073504254OtherUNITED HEALTHCARE
VAPAROtherCIGNA
VA1073504254Medicaid
VA1073504254OtherVIRGINIA PREMIER HEALTH PLAN
VA10133134OtherOPTIMA HEALTH
NC1073504254Medicaid
VAPAROtherAETNA
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
1073504254OtherCOVENTRY NETWORK
VAPAROtherCIGNA
VAPAROtherAETNA
VA1073504254OtherTRICARE/CHAMPUS
VA1073504254Medicaid
VA520694OtherANTHEM BC/BS
VAPAROtherVIRGINIA HEALTH NETWORK