Provider Demographics
NPI:1982656872
Name:ALABANZA, THOMAS MENDOZA (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MENDOZA
Last Name:ALABANZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TOMAS
Other - Middle Name:MENDOZA
Other - Last Name:ALABANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:P.O. BOX 1280
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-1280
Mailing Address - Country:US
Mailing Address - Phone:434-791-4648
Mailing Address - Fax:434-793-2631
Practice Address - Street 1:990 MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1828
Practice Address - Country:US
Practice Address - Phone:434-791-4648
Practice Address - Fax:434-793-2631
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022214207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006092683Medicaid
VAB60120Medicare UPIN
B60120Medicare UPIN
112953515Medicare PIN