Provider Demographics
NPI:1043224751
Name:DAO, TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:DAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1476
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42702-1476
Mailing Address - Country:US
Mailing Address - Phone:270-769-1371
Mailing Address - Fax:270-737-5870
Practice Address - Street 1:1234 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2767
Practice Address - Country:US
Practice Address - Phone:270-769-1371
Practice Address - Fax:270-737-5870
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24203174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000052162OtherBCBS
KY1048860OtherPASSPORT
KY64242035Medicaid