Provider Demographics
NPI:1295920338
Name:TERESA L. DELAWTER, M.D., P.C.
Entity type:Organization
Organization Name:TERESA L. DELAWTER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELAWTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-257-8401
Mailing Address - Street 1:9108 CHURCH ST
Mailing Address - Street 2:UNIT 486
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-8001
Mailing Address - Country:US
Mailing Address - Phone:703-257-8401
Mailing Address - Fax:
Practice Address - Street 1:9108 CHURCH ST.
Practice Address - Street 2:UNIT 486
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20108-8020
Practice Address - Country:US
Practice Address - Phone:703-257-8401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA408992084P0800X
VA01010512332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty