Provider Demographics
NPI:1891873741
Name:TEDESCHI, JOHN P (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:TEDESCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:TEDESCHI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:54 ROBBINSVILLE ALLENTOWN RD
Mailing Address - Street 2:ONE MEDICAL PLAZA
Mailing Address - City:ROBBINSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08691-1625
Mailing Address - Country:US
Mailing Address - Phone:609-259-8440
Mailing Address - Fax:609-259-8747
Practice Address - Street 1:54 ROBBINSVILLE ALLENTOWN RD
Practice Address - Street 2:ONE MEDICAL PLAZA
Practice Address - City:ROBBINSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08691-1625
Practice Address - Country:US
Practice Address - Phone:609-259-8440
Practice Address - Fax:609-259-8747
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0028309207Q00000X
ORMD176662207Q00000X
WAMD60705506207Q00000X
MN64044207Q00000X
AZ18579207Q00000X
IL036146826207Q00000X
WI181-320207Q00000X
IAMD-45442207Q00000X
MEMD22463207Q00000X
KS04-41220207Q00000X
SD11031207Q00000X
NJ25MA046518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5295697OtherAETNA NON-HMO
P2882324OtherOXFORD
1467366OtherINDEPENDENCE BCBS PERSON
1467369OtherINDEPENDENCE BCBS PERSON
481289872OtherQUALCARE MEWA AFFILIATED
2126997840OtherBEECHSTREET
3109163OtherAETNA GROUP
481289872OtherMAGNACARE PPO
2151572000OtherAMERIHEALTH KEYSTONE PIN
2795780OtherAETNA PROVIDER
481289872OtherHEALTHCARE PAYERS COALITI
P00085468OtherMEDICARE RAILROAD
K2968OtherHORIZON BCBS HMO
2151571002OtherAMERIHEALTH KEYSTONE GROU
481289872OtherHORIZON BCBS PPO
481289872OtherHORIZON BCBS PPO
D25070Medicare UPIN