Provider Demographics
NPI:1356423016
Name:SIMON, THERESA SOLA (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:SOLA
Last Name:SIMON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MA.THERESA
Other - Middle Name:R
Other - Last Name:SOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2520 VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT
Mailing Address - State:WV
Mailing Address - Zip Code:25550
Mailing Address - Country:US
Mailing Address - Phone:304-675-4340
Mailing Address - Fax:304-675-6911
Practice Address - Street 1:2520 VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550
Practice Address - Country:US
Practice Address - Phone:304-675-4500
Practice Address - Fax:304-674-4019
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22919207R00000X
OH35-086077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2708976Medicaid
WV3810009604Medicaid
WV3810009604Medicaid
OH2708976Medicaid