Provider Demographics
NPI:1306173646
Name:SOMMESE, TERESA JOY (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:JOY
Last Name:SOMMESE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4006 PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:ISLE OF PALMS
Mailing Address - State:SC
Mailing Address - Zip Code:29451-2051
Mailing Address - Country:US
Mailing Address - Phone:703-623-9696
Mailing Address - Fax:
Practice Address - Street 1:110 NNPTC CIR
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-6314
Practice Address - Country:US
Practice Address - Phone:843-794-6567
Practice Address - Fax:843-794-6567
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
VA01010388552083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No171000000XOther Service ProvidersMilitary Health Care Provider