Provider Demographics
NPI:1124182316
Name:VAN WOY, TERESA MARIE (DPM)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:VAN WOY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2089 VALE RD
Mailing Address - Street 2:12
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3847
Mailing Address - Country:US
Mailing Address - Phone:510-232-0892
Mailing Address - Fax:510-234-5951
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:12
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-232-0892
Practice Address - Fax:510-234-5951
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4247213EP1101X
CAE-4247213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU81999Medicare UPIN
CAU81999Medicare UPIN