Provider Demographics
NPI:1184721896
Name:BLANCHARD, THOMAS RANDALL (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:RANDALL
Last Name:BLANCHARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:T.
Other - Middle Name:RANDALL
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:895 CITY CENTER BLVD
Mailing Address - Street 2:SUITE #300
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3080
Mailing Address - Country:US
Mailing Address - Phone:757-873-3500
Mailing Address - Fax:757-591-5240
Practice Address - Street 1:895 CITY CENTER BLVD
Practice Address - Street 2:SUITE #300
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3080
Practice Address - Country:US
Practice Address - Phone:757-873-3500
Practice Address - Fax:757-591-5240
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058624208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05349OtherMEDICARE GROUP NUMBER
VAC05349OtherMEDICARE GROUP NUMBER
VA6901310Medicaid