Basic Information
| Provider Information | |||||||||
| NPI: | 1144235953 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAHLEDA | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1430 | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228031430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405645791 | ||||||||
| FaxNumber: | 5405647038 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 CANTRELL AVE | ||||||||
| Address2: | |||||||||
| City: | HARRISONBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 228013248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5405647364 | ||||||||
| FaxNumber: | 5405647365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 11/20/2009 | ||||||||
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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 | 0101238634 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 180765 | 01 | ANTHEM/BCBS | OTHER | 322621 | 01 | SOUTHERN HEALTH | OTHER | 3810003095 | 01 | WV | WV MEDICAID | OTHER | 010197473 | 05 | VA | MEDICAID | 97056 | 01 | VA | OPTIMA | OTHER | P00269548 | 01 | RAILROAD MEDICARE | OTHER | 8411004 | 01 | VA | CIGNA | OTHER | 1000870001 | 01 | VA | DME PROVIDER | OTHER |