Basic Information
| Provider Information | |||||||||
| NPI: | 1407814833 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BENDER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11835 FISHING POINT DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236062584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575995588 | ||||||||
| FaxNumber: | 7575996893 | ||||||||
| Practice Location | |||||||||
| Address1: | 11835 FISHING POINT DR | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | NEWPORT NEWS | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236062584 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7575995588 | ||||||||
| FaxNumber: | 7575996893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 03/11/2011 | ||||||||
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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 | 363AM0700X | 0110840152 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 1407814833 | 05 | VA | MEDICAID |