Provider Demographics
NPI:1659084978
Name:MORGAN, THOMAS KEVIN (PA-C)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:KEVIN
Last Name:MORGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:750 BALDWIN AVE APT A6
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23517-1829
Mailing Address - Country:US
Mailing Address - Phone:313-550-3805
Mailing Address - Fax:
Practice Address - Street 1:400 W BRAMBLETON AVE STE 100
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1115
Practice Address - Country:US
Practice Address - Phone:757-627-6220
Practice Address - Fax:757-627-0700
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110009420363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty