Provider Demographics
NPI:1205813672
Name:TACOPINA, TERESA A (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:TACOPINA
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 1:129 ROUTE 37 W
Mailing Address - Street 2:SUITE4
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6435
Mailing Address - Country:US
Mailing Address - Phone:732-797-3990
Mailing Address - Fax:732-797-3995
Practice Address - Street 1:129 ROUTE 37 W
Practice Address - Street 2:SUITE4
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6435
Practice Address - Country:US
Practice Address - Phone:732-797-3990
Practice Address - Fax:732-797-3995
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08585200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110009713Medicare ID - Type Unspecified
I45584Medicare UPIN