Provider Demographics
NPI:1093798357
Name:THORNBERRY, CHRISTA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTA
Middle Name:MARIE
Last Name:THORNBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3013 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2420
Mailing Address - Country:US
Mailing Address - Phone:143-888-5233
Mailing Address - Fax:276-835-4697
Practice Address - Street 1:3013 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-2420
Practice Address - Country:US
Practice Address - Phone:314-888-5233
Practice Address - Fax:276-835-4697
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101 057666208000000X
MDD85301208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA136847OtherBLUE CROSS
VA6737111Medicaid
G80333Medicare UPIN