MEDICARE: THERESA SIMON MD, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35-086077	WV

General Provider Information

NPI Number	:	1699908160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THERESA SIMON MD, PLLC

Provider Business Mailing Address
First Line	:	2924 JACKSON AVE
Second Line	:
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-1716
Country	:	US
Telephone Number	:	304-675-4912
Fax Number	:	304-675-4311

Provider Business Practice Location Address
First Line	:	2924 JACKSON AVE
Second Line	:
City	:	PT PLEASANT
State	:	WV
Zip	:	25550-1716
Country	:	US
Telephone Number	:	304-675-4912
Fax Number	:	304-675-4311

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	THERESA SIMON
Credential	:	MD
Telephone Number	:	304-675-4912

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	09/18/2009

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