Provider Demographics
NPI:1932137346
Name:MACKENZIE, THOMAS ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALEXANDER
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:739 THIMBLE SHOALS BLVD
Practice Address - Street 2:STE 801
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3585
Practice Address - Country:US
Practice Address - Phone:757-873-1009
Practice Address - Fax:757-873-7689
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101031323207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E38629Medicare UPIN
VA1932137346Medicaid
VAP00634557Medicare PIN
VA018135R53Medicare PIN