Provider Demographics
NPI:1750453742
Name:TEDFORD, MICHAEL G I (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:TEDFORD
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:254 ROUTE 17K STE 204
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-8300
Mailing Address - Country:US
Mailing Address - Phone:845-561-4466
Mailing Address - Fax:845-561-7190
Practice Address - Street 1:254 ROUTE 17K STE 204
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550
Practice Address - Country:US
Practice Address - Phone:845-561-4466
Practice Address - Fax:845-561-7190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2018-08-28
Deactivation Date:
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Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203269207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01899169Medicaid
NYG83994Medicare UPIN
NY98T90XPWX1Medicare PIN