Basic Information
| Provider Information | |||||||||
| NPI: | 1376834283 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAINTER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 19 KNOTTY PINE DR | ||||||||
| Address2: | |||||||||
| City: | MOUNT VERNON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 043523640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178558233 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 113 GAINSBOROUGH SQ STE 400 | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233201714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578424499 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2011 | ||||||||
| LastUpdateDate: | 11/10/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME115595 | FL | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD23957 | ME | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 0101272650 | VA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0101272650 | 01 | VA | LICENSE | OTHER |