Provider Demographics
NPI:1881657666
Name:JANUS, THOMAS (DO)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:JANUS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 EXECUTIVE CENTER PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3100
Mailing Address - Country:US
Mailing Address - Phone:540-374-5097
Mailing Address - Fax:540-374-0378
Practice Address - Street 1:418 CHATHAM SQUARE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2561
Practice Address - Country:US
Practice Address - Phone:540-371-4700
Practice Address - Fax:540-373-0942
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5660599Medicaid
VA5660599Medicaid
VAC36567Medicare UPIN