Provider Demographics
NPI:1114011962
Name:HUMARAN, TERESA J (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:J
Last Name:HUMARAN
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 1:3 COOPER PLZ
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-342-2328
Mailing Address - Fax:856-541-6137
Practice Address - Street 1:3 COOPER PLZ
Practice Address - Street 2:SUITE 307
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-2328
Practice Address - Fax:856-541-6137
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA0770452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
3K6032OtherHEALTHNET
P00163811OtherRR MEDICARE
NJ2349040000OtherAMERIHEALTH, KEYSTONE, IBC
NJ0043036Medicaid
1676860OtherPENNSYLVANIA BLUE SHIELD
42316OtherUNIVERSITY HEALTHPLAN
NJ3630099OtherAETNA
P3451609OtherOXFORD HEALTHPLAN
2566624OtherUNITED HEALTHCARE
NJ3630099OtherAETNA
P3451609OtherOXFORD HEALTHPLAN