Provider Demographics
NPI:1023217221
Name:LIVENGOOD, TEODORA ANDREEA (DO)
Entity Type:Individual
Prefix:
First Name:TEODORA
Middle Name:ANDREEA
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 2087
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-0021
Mailing Address - Country:US
Mailing Address - Phone:49638-334-1082
Mailing Address - Fax:
Practice Address - Street 1:CMR 402 BOX 2087
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-0021
Practice Address - Country:US
Practice Address - Phone:491515-307-5765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.009844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine