Provider Demographics
NPI:1851617120
Name:KERGE, TERESA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:KERGE
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 1:3310 FALL HILL AVE
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3000
Mailing Address - Country:US
Mailing Address - Phone:540-373-4602
Mailing Address - Fax:540-373-5461
Practice Address - Street 1:2549 COWAN BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8440
Practice Address - Country:US
Practice Address - Phone:540-368-3970
Practice Address - Fax:540-368-3973
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101259196208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C09813OtherMEDICARE GROUP PTAN
1457308611OtherMEDICARE GROUP NPI
VA0101259196OtherMEDICAL LICENSE
1851617120OtherNPI
FK5650230OtherDEA