Provider Demographics
NPI:1396865440
Name:LAWFORD, THOMAS C (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:LAWFORD
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 1:2148 GLENCOURSE LN
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1317
Mailing Address - Country:US
Mailing Address - Phone:703-476-5155
Mailing Address - Fax:888-854-8839
Practice Address - Street 1:2148 GLENCOURSE LN
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1317
Practice Address - Country:US
Practice Address - Phone:703-476-5155
Practice Address - Fax:888-854-8839
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010198962083P0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine