Basic Information
Provider Information
NPI: 1780064303
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCELROY
FirstName: THOMAS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 501 SUNSET LN
Address2:  
City: CULPEPER
State: VA
PostalCode: 227013917
CountryCode: US
TelephoneNumber: 5408298838
FaxNumber: 5408298898
Practice Location
Address1: 501 SUNSET LN
Address2:  
City: CULPEPER
State: VA
PostalCode: 227013917
CountryCode: US
TelephoneNumber: 5408298838
FaxNumber: 5408298898
Other Information
ProviderEnumerationDate: 06/09/2015
LastUpdateDate: 06/09/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0024172653VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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