Provider Demographics
NPI:1437264546
Name:TEDTAOTAO, MARIA UNCANGCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:UNCANGCO
Last Name:TEDTAOTAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 MOSLEY DR
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5625
Mailing Address - Country:US
Mailing Address - Phone:850-271-5996
Mailing Address - Fax:850-271-4088
Practice Address - Street 1:1303 MOSLEY DR
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5625
Practice Address - Country:US
Practice Address - Phone:850-712-5996
Practice Address - Fax:850-271-4088
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258053500Medicaid
FL41375AMedicare ID - Type Unspecified
FLF44261Medicare UPIN