Provider Demographics
NPI:1609005396
Name:BOHRT TERCEROS, VALERIA (MD)
Entity Type:Individual
Prefix:
First Name:VALERIA
Middle Name:
Last Name:BOHRT TERCEROS
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 1:1925 GLENN MITCHELL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0177
Mailing Address - Country:US
Mailing Address - Phone:757-507-0900
Mailing Address - Fax:757-301-6462
Practice Address - Street 1:1925 GLENN MITCHELL DR STE 202
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0177
Practice Address - Country:US
Practice Address - Phone:757-507-0900
Practice Address - Fax:757-301-6462
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014029971207R00000X, 207RE0101X
VA0116024325390200000X
VA0101268790207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO151140021Medicare UPIN