Provider Demographics
NPI:1518958420
Name:THOMAS, FRED NICHOLAS III (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:NICHOLAS
Last Name:THOMAS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-232-8769
Mailing Address - Fax:757-232-8875
Practice Address - Street 1:2205 EXECUTIVE DR STE A
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2948
Practice Address - Country:US
Practice Address - Phone:757-223-4992
Practice Address - Fax:757-223-5350
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2022-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101238297207RA0401X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1518958420Medicaid
VA011041100Medicare PIN