Provider Demographics
NPI:1750660627
Name:M. TERESA TALLON, M.D.
Entity Type:Organization
Organization Name:M. TERESA TALLON, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:M. TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-497-0602
Mailing Address - Street 1:2821 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1668
Mailing Address - Country:US
Mailing Address - Phone:260-497-0602
Mailing Address - Fax:260-497-0657
Practice Address - Street 1:2821 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1668
Practice Address - Country:US
Practice Address - Phone:260-497-0602
Practice Address - Fax:260-497-0657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty