Provider Demographics
NPI:1790810307
Name:BELFORD, THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BELFORD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 LYNN AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25523-1138
Mailing Address - Country:US
Mailing Address - Phone:304-824-5806
Mailing Address - Fax:304-824-5804
Practice Address - Street 1:7400 LYNN AVE
Practice Address - Street 2:
Practice Address - City:HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25523-1138
Practice Address - Country:US
Practice Address - Phone:304-824-5806
Practice Address - Fax:304-824-5804
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00780363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810000494Medicaid
WVWV2221JMedicare Oscar/Certification
WV2024103Medicare Oscar/Certification
WVWV2221GMedicare Oscar/Certification
WVWV2221BMedicare Oscar/Certification
WVWV2221IMedicare Oscar/Certification
WVWV2221HMedicare Oscar/Certification
WVWV2221CMedicare Oscar/Certification
WVWV2221AMedicare Oscar/Certification
WVWV2221EMedicare Oscar/Certification