Provider Demographics
NPI:1942520499
Name:RECKER GROSS, TERESA ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ROSE
Last Name:RECKER GROSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:ROSE
Other - Last Name:RECKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:551 W CENTRAL AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-1493
Mailing Address - Country:US
Mailing Address - Phone:740-615-0300
Mailing Address - Fax:740-615-0301
Practice Address - Street 1:551 W CENTRAL AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1493
Practice Address - Country:US
Practice Address - Phone:740-615-0300
Practice Address - Fax:740-615-0301
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34011085208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics