Provider Demographics
NPI:1497958771
Name:PARROTT, TERESA D (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:D
Last Name:PARROTT
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 1:225 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-3014
Mailing Address - Country:US
Mailing Address - Phone:606-218-3500
Mailing Address - Fax:
Practice Address - Street 1:225 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-3014
Practice Address - Country:US
Practice Address - Phone:606-663-0333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50441-020207L00000X
IN01039879A207L00000X
KY24500207RA0401X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN64245004Medicaid
WI50441-020OtherWISCONSIN MD LICENSE
KY0399884Medicare PIN
KYC63920Medicare UPIN
IN64245004Medicaid