Provider Demographics
NPI:1154320182
Name:BRIDGES, TERESA PAMELA (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:PAMELA
Last Name:BRIDGES
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 1:13286 OVITT RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-9610
Mailing Address - Country:US
Mailing Address - Phone:419-823-6800
Mailing Address - Fax:
Practice Address - Street 1:13286 OVITT RD
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-9610
Practice Address - Country:US
Practice Address - Phone:419-823-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052277207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000246971OtherANTHEM
OH000000259183OtherANTHEM
MI4485563Medicaid
OH0660226Medicaid
OH930073634Medicare ID - Type UnspecifiedRAILROAD
OHF06128Medicare UPIN
OHBR7303311Medicare ID - Type Unspecified
OH0660226Medicaid
OH930121166Medicare ID - Type UnspecifiedRAILROAD