Basic Information
| Provider Information | |||||||||
| NPI: | 1154355824 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEARSALL | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | BALLOU | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4299 SAN FELIPE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770272916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324763900 | ||||||||
| FaxNumber: | 8324763990 | ||||||||
| Practice Location | |||||||||
| Address1: | 5801 BREMO ROAD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850620 | ||||||||
| FaxNumber: | 8042850726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 06/08/2010 | ||||||||
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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 | 0101237889 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 010206979 | 05 | VA | MEDICAID | P00265942 | 01 | RAILROAD MEDICARE | OTHER |