Provider Demographics
NPI:1245280536
Name:SADDORIS, THEODORA (MD)
Entity type:Individual
Prefix:MRS
First Name:THEODORA
Middle Name:
Last Name:SADDORIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2753 FOX POINTE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3224
Mailing Address - Country:US
Mailing Address - Phone:812-376-7824
Mailing Address - Fax:812-378-8390
Practice Address - Street 1:2753 FOX POINTE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3224
Practice Address - Country:US
Practice Address - Phone:812-376-7824
Practice Address - Fax:812-378-8390
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033704A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000086963OtherANTHEM
003640OtherSIHO
054210AMedicare ID - Type Unspecified
000000086963OtherANTHEM