Provider Demographics
NPI:1598254559
Name:DETERESA, CATHERINE A (MD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:DETERESA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 W BROAD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230
Mailing Address - Country:US
Mailing Address - Phone:804-662-6138
Mailing Address - Fax:804-288-3567
Practice Address - Street 1:6600 W BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-662-6138
Practice Address - Fax:804-288-3567
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101275302207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program