Provider Demographics
NPI:1578090296
Name:SWIDINSKY, TEDDI (MD)
Entity Type:Individual
Prefix:DR
First Name:TEDDI
Middle Name:
Last Name:SWIDINSKY
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 1:1900 HOT SPRINGS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-3480
Mailing Address - Country:US
Mailing Address - Phone:505-426-3795
Mailing Address - Fax:
Practice Address - Street 1:108 LEGION DR STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4898
Practice Address - Country:US
Practice Address - Phone:505-426-3795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD-2018-0086208600000X
AZ42110208600000X
ZZ92292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery