Provider Demographics
NPI:1922099365
Name:THOMSON, ROY VARGHESE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROY
Middle Name:VARGHESE
Last Name:THOMSON
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 CVPI
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641
Mailing Address - Country:US
Mailing Address - Phone:276-964-6771
Mailing Address - Fax:276-964-1206
Practice Address - Street 1:ONE CLINIC DRIVE
Practice Address - Street 2:CLAYPOOL HILL
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-1100
Practice Address - Country:US
Practice Address - Phone:276-964-6771
Practice Address - Fax:276-964-1206
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048293208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
036643OtherANTHEM BCBS
KY64008899Medicaid
VA6710131Medicaid
WV0110075-000Medicaid
036643OtherANTHEM BCBS