Provider Demographics
NPI:1497966790
Name:ANDERSON, TERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:ANDERSON
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 1:2567 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-2018
Mailing Address - Country:US
Mailing Address - Phone:513-321-1753
Mailing Address - Fax:513-321-9888
Practice Address - Street 1:2567 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-2018
Practice Address - Country:US
Practice Address - Phone:513-321-1753
Practice Address - Fax:513-321-9888
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.0917962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry