Provider Demographics
NPI:1942207725
Name:ODER, TERRENCE FREDERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:FREDERIC
Last Name:ODER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-1121
Mailing Address - Country:US
Mailing Address - Phone:860-241-0700
Mailing Address - Fax:860-525-7881
Practice Address - Street 1:3580 MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-1121
Practice Address - Country:US
Practice Address - Phone:860-241-0700
Practice Address - Fax:860-525-7881
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT046133207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT046133OtherLICENSE