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General NPI Number Information
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NPI Number | 1235212200
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Entity Type | Individual
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Provider Name | TERESA L. DELAWTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 9108 CHURCH ST UNIT 486
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City | MANASSAS
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State | VA
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Zip | 20108-8001
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Country | US
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Telephone | 703-257-8401
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Fax | 703-753-2868
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Provider Business Mailing Address
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Address Line | 9108 CHURCH ST UNIT 486
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City | MANASSAS
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State | VA
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Zip | 20108-8020
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Country | US
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Telephone | 703-257-8401
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Fax | 703-335-7049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 0101051233
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | BOARD CERT # 40899
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License Number State | VA
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