Basic Information
| Provider Information | |||||||||
| NPI: | 1619985926 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | WESLEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3241 WESTERN BRANCH BLVD | ||||||||
| Address2: | |||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233215260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7576863508 | ||||||||
| FaxNumber: | 7576860541 | ||||||||
| Practice Location | |||||||||
| Address1: | 816 INDEPENDENCE BLVD | ||||||||
| Address2: | STE 1H | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574642013 | ||||||||
| FaxNumber: | 7574643046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 07/31/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 0101056073 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 0101056073 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | DR.0055184 | CO | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 23519 | 01 | VA | SENTARA | OTHER | 139607 | 01 | VA | ANTHEM | OTHER | 005857643 | 05 | VA | MEDICAID |