Provider Demographics
NPI:1518967207
Name:RALEY, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:RALEY
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 1:450 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554
Mailing Address - Country:US
Mailing Address - Phone:703-522-2727
Mailing Address - Fax:540-288-3327
Practice Address - Street 1:450 GARRISONVILLE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:703-522-2727
Practice Address - Fax:540-288-3327
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037178207X00000X
VA0101243103207X00000X
MDD0068746207X00000X
PAMD425955207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
133047XFXXMedicare PIN
PA089753EKHMedicare ID - Type Unspecified
VA6714560002Medicare NSC
I27437Medicare UPIN