Provider Demographics
NPI:1639143761
Name:TWAROG, TOM W (RN)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:W
Last Name:TWAROG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 SKIPJACK CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6309
Mailing Address - Country:US
Mailing Address - Phone:757-953-0493
Mailing Address - Fax:757-953-7478
Practice Address - Street 1:NMCP 620 JOHN PAUL JONES CIRCLE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-5100
Practice Address - Country:US
Practice Address - Phone:757-953-0493
Practice Address - Fax:757-953-7478
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001136300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse