Provider Demographics
NPI:1407814833
Name:BENDER, THOMAS ALAN (PA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALAN
Last Name:BENDER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:11835 FISHING POINT DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2584
Mailing Address - Country:US
Mailing Address - Phone:757-599-5588
Mailing Address - Fax:757-599-6893
Practice Address - Street 1:11835 FISHING POINT DR
Practice Address - Street 2:SUITE 104
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2584
Practice Address - Country:US
Practice Address - Phone:757-599-5588
Practice Address - Fax:757-599-6893
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840152363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1407814833Medicaid
VA019924J36Medicare PIN