Provider Demographics
NPI:1760442966
Name:SOTO, THERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:SOTO
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Gender:F
Credentials:MD
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Mailing Address - Street 1:7474 GREENWAY CENTER DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3504
Mailing Address - Country:US
Mailing Address - Phone:240-965-3258
Mailing Address - Fax:240-473-4321
Practice Address - Street 1:150 ELDEN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4861
Practice Address - Country:US
Practice Address - Phone:855-830-8346
Practice Address - Fax:240-473-4321
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2016-04-26
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Provider Licenses
StateLicense IDTaxonomies
VA0101221215207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAO708812Medicare PIN
VAG00710Medicare PIN
VAI17315Medicare UPIN