Provider Demographics
NPI:1124570817
Name:TERON COSME, ESTEFANIA (MD)
Entity Type:Individual
Prefix:
First Name:ESTEFANIA
Middle Name:
Last Name:TERON COSME
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 1:5514 WENRICH DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2400
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:JIMMY EVEREST CENTER FOR CANCER AND BLOOD DISORDERS
Practice Address - Street 2:1200 CHILDRENS AVENUE
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OH
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-3741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR214332080P0207X, 208D00000X, 208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program