Provider Demographics
NPI:1750338182
Name:GEORGE, THOMAS NEDUMKALLEL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:NEDUMKALLEL
Last Name:GEORGE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5613 HOUNDMASTER RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6517
Mailing Address - Country:US
Mailing Address - Phone:804-608-8274
Mailing Address - Fax:
Practice Address - Street 1:1201 BROAD ROCK BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249-0001
Practice Address - Country:US
Practice Address - Phone:804-675-5542
Practice Address - Fax:804-675-5509
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2011-06-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101234503207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G70708Medicare UPIN