Individual
THERESA VICTORIA FORTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1900 ELECTRIC RD, SALEM, VA 24153
(540) 776-4000
Mailing address
11885 E 12 MILE RD STE 300A, WARREN, MI 48093-3467
(586) 582-6630
(586) 582-6631
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0102205314
VA
207R00000X
Internal Medicine Physician
5101020889
MI
Other
Enumeration date
04/07/2014
Last updated
06/19/2018
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