Provider Demographics
NPI:1265441711
Name:TERESA D TODD MD PA
Entity Type:Organization
Organization Name:TERESA D TODD MD PA
Other - Org Name:WOODLAND HEIGHTS PATHOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-632-5920
Mailing Address - Street 1:PO BOX 1907
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1907
Mailing Address - Country:US
Mailing Address - Phone:936-632-5920
Mailing Address - Fax:936-632-5470
Practice Address - Street 1:505 SOUTH JOHN REDDITT DRIVE
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3120
Practice Address - Country:US
Practice Address - Phone:936-634-8311
Practice Address - Fax:936-637-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0014MNOtherBLUE CROSS BLUE SHIELD TX
TXDD4409Medicare PIN
TX00670YMedicare PIN