Provider Demographics
NPI:1003871989
Name:SIMON, THRESA HELEN (MD)
Entity Type:Individual
Prefix:
First Name:THRESA
Middle Name:HELEN
Last Name:SIMON
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 1:269 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-9337
Mailing Address - Country:US
Mailing Address - Phone:804-861-0700
Mailing Address - Fax:804-863-4626
Practice Address - Street 1:269 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9337
Practice Address - Country:US
Practice Address - Phone:804-861-0700
Practice Address - Fax:804-863-4626
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01018404052084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry