Healthcare Provider Details

I. General information

NPI: 1609005396
Provider Name (Legal Business Name): VALERIA BOHRT TERCEROS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2009
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 GLENN MITCHELL DR STE 202
VIRGINIA BEACH VA
23456-0177
US

IV. Provider business mailing address

1925 GLENN MITCHELL DR STE 202
VIRGINIA BEACH VA
23456-0177
US

V. Phone/Fax

Practice location:
  • Phone: 757-507-0900
  • Fax: 757-301-6462
Mailing address:
  • Phone: 757-507-0900
  • Fax: 757-301-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0116024325
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2014029971
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number2014029971
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number0101268790
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: