Provider Demographics
NPI:1639244841
Name:THOMA, ROBERT BENEDICT (DC, PC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BENEDICT
Last Name:THOMA
Suffix:
Gender:M
Credentials:DC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 SUNSTATES CT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-1552
Mailing Address - Country:US
Mailing Address - Phone:757-481-5444
Mailing Address - Fax:757-481-0048
Practice Address - Street 1:2244 SUNSTATES CT
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-1552
Practice Address - Country:US
Practice Address - Phone:757-481-5444
Practice Address - Fax:757-481-0048
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000576111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA076212OtherBLUE CROSS BLUE SHIELD
VA52788OtherOPTIMA
VA541356929OtherTAX ID
VAT21415Medicare UPIN
VA52788OtherOPTIMA
VA350038248Medicare ID - Type UnspecifiedMEDICARE RAILROAD