Provider Demographics
NPI:1417020496
Name:TEREM, THERESA M (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:M
Last Name:TEREM
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 1:3315 S 23RD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1616
Mailing Address - Country:US
Mailing Address - Phone:253-552-1200
Mailing Address - Fax:253-552-1239
Practice Address - Street 1:3315 S 23RD ST STE 200
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1616
Practice Address - Country:US
Practice Address - Phone:253-552-1200
Practice Address - Fax:253-552-1239
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0257059OtherSTATE L&I
WATE2772OtherREGENCE BLUE SHIELD
WA1029420Medicaid
WATE2772OtherPREMERA BLUE CROSS
WA0257059OtherSTATE L&I
WATE2772OtherPREMERA BLUE CROSS
WAG887747Medicare PIN