Provider Demographics
NPI:1659356079
Name:DOTSON, THOMAS CHARLES (MDPC)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHARLES
Last Name:DOTSON
Suffix:
Gender:M
Credentials:MDPC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-361-5116
Mailing Address - Fax:703-361-5876
Practice Address - Street 1:10945 GEORGE MASON CIR STE 105
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-2234
Practice Address - Country:US
Practice Address - Phone:703-361-5116
Practice Address - Fax:571-364-8911
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2020-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101224961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5845246Medicaid
VA1659356079Medicaid
VAC09489Medicare UPIN
VA1659356079Medicaid