Basic Information
| Provider Information | |||||||||
| NPI: | 1760457873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEVAN | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 BUSINESS PARK DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | VIRGINIA BEACH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234626535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579621083 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 KINGSLEY LN | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235054604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7578896768 | ||||||||
| FaxNumber: | 7579621254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2006 | ||||||||
| LastUpdateDate: | 03/24/2009 | ||||||||
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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 | 207RC0000X | 0101040686 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 0518P | 01 | VA | BC/BS NC | OTHER | 086977 | 01 | VA | ANTHEM BC/BS | OTHER | 263654 | 01 | VA | UHC/MAMSI/MDIPA | OTHER | PAR | 01 | VA | AETNA | OTHER | 006033440 | 05 | VA | MEDICAID | 15602 | 01 | VA | OPTIMA HEALTH PLAN | OTHER | 250467 | 01 | VA | ATHEM BC/BS VA/HK | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | 006096166 | 05 | VA | MEDICAID | 15792 | 01 | VA | SENTARA OHP/SHP | OTHER | 890518P | 05 | NC | MEDICAID | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | PAR | 01 | VA | CIGNA | OTHER | 249500 | 01 | VA | MAMSI | OTHER | PAR | 01 | VA | TRICARE/CHAMPUS | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER |