Provider Demographics
NPI:1902110315
Name:RAMERTH, TERESA S (M D)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:S
Last Name:RAMERTH
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:M
Other - Last Name:STATHAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8413 OVERLOOK ST
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5145
Mailing Address - Country:US
Mailing Address - Phone:703-876-0212
Mailing Address - Fax:
Practice Address - Street 1:209 W CRISER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FRONT ROYAL
Practice Address - State:VA
Practice Address - Zip Code:22630-2360
Practice Address - Country:US
Practice Address - Phone:540-636-4250
Practice Address - Fax:540-636-7171
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012310202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215930573Medicaid