Provider Demographics
NPI:1649359993
Name:KIMBLE, THOMAS DUDLEY (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:DUDLEY
Last Name:KIMBLE
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-625-0557
Mailing Address - Fax:757-625-1361
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-625-0557
Practice Address - Fax:757-625-1361
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10015910OtherSENTARA
VAPAROtherUSA MANAGED CARE
NC06151OtherBC/BS
VA1649359993Medicaid
NC5906151Medicaid
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherMULTIPLAN
VAPAROtherCORVEL/CORCARE
VA-010OtherTRICARE/CHAMPUS
VA2165745OtherUHC/MAMSI (OB/GYN)
VA293664OtherANTHEM
VA3166745OtherUHC/MAMSI (GYN)
VAPAROtherCIGNA
VAPAROtherAETNA
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
VAPAROtherVIRGINIA PREMIER HEALTH