Provider Demographics
NPI:1780704171
Name:DAYSPRING, THOMAS D (MD, FACP)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:DAYSPRING
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 SHEPPARDS WAY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-1940
Mailing Address - Country:US
Mailing Address - Phone:201-723-7092
Mailing Address - Fax:
Practice Address - Street 1:10701 SHEPPARDS WAY DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-1940
Practice Address - Country:US
Practice Address - Phone:201-723-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02736300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC63117Medicare UPIN
NJ527753Medicare ID - Type Unspecified