Provider Demographics
NPI:1093708513
Name:HEGERICH, THOMAS JEROME (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JEROME
Last Name:HEGERICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6001
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:205 E. HIRST ROAD, SUITE 303
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6602
Practice Address - Country:US
Practice Address - Phone:540-338-9896
Practice Address - Fax:540-338-8235
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1093708513Medicaid
VA5618274Medicaid
VA080156027OtherRR MEDICARE
VA05607337Medicaid
VA5618274Medicaid