Provider Demographics
NPI:1811949613
Name:EPPERSON, THOMAS IRVING JR (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:IRVING
Last Name:EPPERSON
Suffix:JR
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 1:3000 WATERCOVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3982
Mailing Address - Country:US
Mailing Address - Phone:804-744-0200
Mailing Address - Fax:
Practice Address - Street 1:3510-A ANDERSON HWY.
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7406
Practice Address - Country:US
Practice Address - Phone:804-598-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030811207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA178486OtherANTHEM
VA8132260OtherMAMSI
VA010177359Medicaid
VA0107662OtherUNITED HEALTHCARE
VA540883363OtherCHAMPUS-TRICARE
VA540883363OtherVIRGINIA HEALTH NETWORK
VA540883363OtherPHCS
VA1439641OtherCIGNA
VA10003380OtherOPTIMA
VA317473OtherSOUTHERN HEALTH
VA540883363OtherGREAT WEST HEALTHCARE
VA540883363OtherPREFERRED CARE
VA5232281OtherAETNA
VA540883363OtherFIRST HEALTH/CCN
VA016204V26Medicare PIN
VA8132260OtherMAMSI
VA540883363OtherVIRGINIA HEALTH NETWORK
VAP00257010Medicare PIN
VA016333V28Medicare PIN