1528125978 NPI number — DR. TERESA N. UNDERWOOD MD

Table of content: DR. TERESA N. UNDERWOOD MD (NPI 1528125978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528125978 NPI number — DR. TERESA N. UNDERWOOD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNDERWOOD
Provider First Name:
TERESA
Provider Middle Name:
N.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILL
Provider Other First Name:
TERESA-TRAM
Provider Other Middle Name:
N
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528125978
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
744 N. MARINE CORPS DRIVE
Provider Second Line Business Mailing Address:
SUITE 121
Provider Business Mailing Address City Name:
TAMUNING
Provider Business Mailing Address State Name:
GUAM
Provider Business Mailing Address Postal Code:
96913
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
744 N. MARINE CORPS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
TAMUNING
Provider Business Practice Location Address State Name:
GUAM
Provider Business Practice Location Address Postal Code:
96913
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
671-588-2394
Provider Business Practice Location Address Fax Number:
877-797-7025
Provider Enumeration Date:
01/03/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  L7418 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: M-1808 , registered in the state of GU ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "SELECTCARE" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".
  • Identifier: PENDING . This is a "NETCARE" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "STAYWELL" identifier , issued by the state of ( GU ) . This identifiers is of the category "OTHER".