Provider Demographics
NPI:1023092301
Name:TOMLINSON, PORTIA S (PA-C)
Entity type:Individual
Prefix:
First Name:PORTIA
Middle Name:S
Last Name:TOMLINSON
Suffix:
Gender:F
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 1:1970 ROANOKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-983-1011
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840614363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010251699Medicaid
VA010008778Medicaid
VA010046190Medicaid
VA8940967Medicaid
VA970025817Medicare PIN
VA004102C95Medicare PIN
VA010251699Medicaid
VA004100C40Medicare PIN
VAP59228Medicare UPIN
VA000251C19Medicare PIN
VA010046190Medicaid
VAP00137116Medicare PIN
015572C19Medicare PIN