Provider Demographics
NPI:1518957661
Name:THOMAS, PETRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PETRA
Middle Name:
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:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-1400
Mailing Address - Country:US
Mailing Address - Phone:703-383-9543
Mailing Address - Fax:703-383-9532
Practice Address - Street 1:7211 BANK CT
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8483
Practice Address - Country:US
Practice Address - Phone:240-215-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235337207RP1001X
MDD48133207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCA6950006OtherDC BS
VA010058937Medicaid
DC013385P37Medicare ID - Type UnspecifiedDC MEDICARE
VA010058937Medicaid
P00122242Medicare ID - Type UnspecifiedRR MEDICARE
G33558Medicare UPIN