Provider Demographics
NPI:1700851672
Name:MANSER, THOMAS JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MANSER
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:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-8920
Mailing Address - Fax:757-446-5242
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:SUITE 445
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-8920
Practice Address - Fax:757-446-5242
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036716207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006028667Medicaid
VAPAROtherUSA MANAGED CARE
VAPAROtherCIGNA
VAPAROtherCORVEL/CORCARE
VAPAROtherAETNA
NC06221OtherBC/BS
VA12097OtherSENTARA OPTIMA
NC8906221Medicaid
VA227463OtherUHC/MAMSI
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VA-028OtherTRICARE/CHAMPUS
VA081965OtherANTHEM
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherMULTIPLAN
VA081965OtherANTHEM
VAPAROtherVIRGINIA PREMIER HEALTH
VA110067866Medicare PIN