Provider Demographics
NPI:1083601124
Name:TEDESCO, KAREN (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TEDESCO
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 1:1700 RIVERFRONT CTR
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4620
Mailing Address - Country:US
Mailing Address - Phone:518-843-0020
Mailing Address - Fax:
Practice Address - Street 1:1700 RIVERFRONT CTR
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4620
Practice Address - Country:US
Practice Address - Phone:518-843-0020
Practice Address - Fax:518-843-0023
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231176207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA2377Medicare PIN
P00145540Medicare PIN
I04656Medicare UPIN
2Z18085471Medicare PIN
P00722021Medicare PIN
2Z1802Medicare PIN