Provider Demographics
NPI:1871505768
Name:THOMAS, POTTAYIL VARKEY (M D)
Entity type:Individual
Prefix:DR
First Name:POTTAYIL
Middle Name:VARKEY
Last Name:THOMAS
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9170
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-0170
Mailing Address - Country:US
Mailing Address - Phone:757-440-9000
Mailing Address - Fax:
Practice Address - Street 1:1047 ALGONQUIN RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3173
Practice Address - Country:US
Practice Address - Phone:757-440-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101022389207L00000X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5766613Medicaid
VA5766613Medicaid