Provider Demographics
NPI:1568462190
Name:THOMAS, BARTON ALAN (MD)
Entity Type:Individual
Prefix:
First Name:BARTON
Middle Name:ALAN
Last Name:THOMAS
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 1:1118 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-4702
Mailing Address - Country:US
Mailing Address - Phone:540-581-1400
Mailing Address - Fax:540-581-1401
Practice Address - Street 1:1118 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-4702
Practice Address - Country:US
Practice Address - Phone:540-581-1400
Practice Address - Fax:540-581-1401
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010507992086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00690189Medicaid
VA00690189Medicaid
E72642Medicare UPIN