Provider Demographics
NPI:1932240900
Name:THORN, ERIC MILLER (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MILLER
Last Name:THORN
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 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 354
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-7780
Mailing Address - Fax:703-717-7781
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 354
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-7780
Practice Address - Fax:703-717-7781
Is Sole Proprietor?:No
Enumeration Date:2007-02-10
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245135207RB0002X, 207UN0901X, 207RC0000X
MDD0065962207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD896942-01OtherBLUE CROSS/BLUE SHIELD
MD4127323-00Medicaid
MD896942-01OtherBLUE CROSS/BLUE SHIELD
MDQ764Medicare PIN
VAC09878Medicare PIN
DC148699ZAMTMedicare PIN
VA018904M83Medicare PIN
MD4127323-00Medicaid
DCG00773Medicare PIN
MDP00431247Medicare PIN
VAC06380Medicare PIN