Provider Demographics
NPI:1497778559
Name:THOMAS, DEBRA JANINE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:JANINE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CEDAR VALLEY DR
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-9184
Mailing Address - Country:US
Mailing Address - Phone:276-596-9064
Mailing Address - Fax:276-596-9097
Practice Address - Street 1:1100 CEDAR VALLEY DR
Practice Address - Street 2:SUITE 3A
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-9184
Practice Address - Country:US
Practice Address - Phone:276-596-9064
Practice Address - Fax:276-596-9097
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248544207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAA110004OtherMEDICARE GROUP PTAN
1467754093OtherGROUP NPI
VA1497778559Medicaid
WV3810019180Medicaid
VAA113140OtherMEDICARE INDIVIDUAL PTAN