Provider Demographics
NPI:1497726376
Name:RENFRO, THOMAS E (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:RENFRO
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 1:515 FRONT ST W
Mailing Address - Street 2:
Mailing Address - City:COEBURN
Mailing Address - State:VA
Mailing Address - Zip Code:24230-3607
Mailing Address - Country:US
Mailing Address - Phone:276-395-2389
Mailing Address - Fax:276-395-6634
Practice Address - Street 1:515 FRONT ST W
Practice Address - Street 2:
Practice Address - City:COEBURN
Practice Address - State:VA
Practice Address - Zip Code:24230-3607
Practice Address - Country:US
Practice Address - Phone:276-395-2389
Practice Address - Fax:276-395-6634
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039754207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1497726376Medicaid
KY6466581300Medicaid
VAVVC193AMedicare PIN
VAC10456Medicare UPIN
VAC10529Medicare UPIN
VA1497726376Medicaid
B06612Medicare UPIN