Vanden Berg, Ma Theresa L.
Vanden Berg, Ma Theresa L. is an individual health care provider with primary practice located at 1718 E Kessler Blvd , Longview WA 98632-1842. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Vanden Berg, Ma Theresa L. can be contacted via phone (360) 747-5800.Contact Information
Primary practice address
1718 E Kessler Blvd
Longview WA 98632-1842
Phone: (360) 747-5800
Fax: (360) 575-3846
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 4301089956 | Michigan |
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | MD60120609 | Washington |
Profile Details
| NPI number | 1952591711 |
|---|---|
| LBN Legal business name | Vanden Berg, Ma Theresa L. |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 27th, 2007 |
| Last updated | Jul 30th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952591711 | NPPES |
| Washington | Other | 0263926 | L & I /CRIME VICTIMS |
| Washington | MEDICAID | 500624616 | L & I /CRIME VICTIMS |
| Washington | MEDICAID | 2008004 | L & I /CRIME VICTIMS |
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