Provider Demographics
NPI:1346223096
Name:YOCUM, TERESA A (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:YOCUM
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 1:918 YOUNGSTOWN WARREN RD
Mailing Address - Street 2:STE C
Mailing Address - City:NILES
Mailing Address - State:OH
Mailing Address - Zip Code:44446-4623
Mailing Address - Country:US
Mailing Address - Phone:330-652-3100
Mailing Address - Fax:330-652-1231
Practice Address - Street 1:918 YOUNGSTOWN WARREN RD
Practice Address - Street 2:STE C
Practice Address - City:NILES
Practice Address - State:OH
Practice Address - Zip Code:44446-4623
Practice Address - Country:US
Practice Address - Phone:330-652-3100
Practice Address - Fax:330-652-1231
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH86298208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2581406Medicaid