Provider Demographics
NPI:1285643742
Name:TODD, TERESA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:TODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0720207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R9360OtherBLUE CROSS BLUE SHIELD TX
TXP00228300Medicare PIN
TX8R9360OtherBLUE CROSS BLUE SHIELD TX
I10101Medicare UPIN