Provider Demographics
NPI:1366647778
Name:BERDEEN, THOMPSON NEAL (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMPSON
Middle Name:NEAL
Last Name:BERDEEN
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 1:6161 RAN LYNN DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-5412
Mailing Address - Country:US
Mailing Address - Phone:540-989-7913
Mailing Address - Fax:
Practice Address - Street 1:6161 RAN LYNN DR
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-5412
Practice Address - Country:US
Practice Address - Phone:540-989-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2400XAmbulatory Health Care FacilitiesClinic/CenterPrison Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB09798Medicare UPIN