Provider Demographics
NPI:1871754028
Name:THORN, RADHIKA M (MD)
Entity type:Individual
Prefix:
First Name:RADHIKA
Middle Name:M
Last Name:THORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14051 ST FRANCIS BLVD STE 2210
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3203
Mailing Address - Country:US
Mailing Address - Phone:804-893-8717
Mailing Address - Fax:804-594-3131
Practice Address - Street 1:14051 ST FRANCIS BLVD STE 2210
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3203
Practice Address - Country:US
Practice Address - Phone:804-893-8717
Practice Address - Fax:804-594-3131
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206960207RH0003X
390200000X
VA0101262562207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08755852Medicaid
LA2373846Medicaid
LA2373846Medicaid