Provider Demographics
NPI:1467452706
Name:O NEILL, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:O NEILL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:159 EXECUTIVE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-4378
Mailing Address - Fax:434-799-0860
Practice Address - Street 1:159 EXECUTIVE DR
Practice Address - Street 2:SUITE F
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-792-4378
Practice Address - Fax:434-799-0860
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2014-01-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA010121076207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006093230Medicaid
VAD73304Medicare UPIN
VA006093230Medicaid