Provider Demographics
NPI:1346226933
Name:PADILLA, TERESA LORRAINE
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:LORRAINE
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 HAWKINS POINT RD
Mailing Address - Street 2:BUILDING 28B
Mailing Address - City:CURTIS BAY
Mailing Address - State:MD
Mailing Address - Zip Code:21226-1797
Mailing Address - Country:US
Mailing Address - Phone:410-636-7506
Mailing Address - Fax:410-636-7868
Practice Address - Street 1:2401 HAWKINS POINT RD
Practice Address - Street 2:BUILDING 28B
Practice Address - City:CURTIS BAY
Practice Address - State:MD
Practice Address - Zip Code:21226-1797
Practice Address - Country:US
Practice Address - Phone:410-636-7506
Practice Address - Fax:410-636-7868
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider